Direct Debit - Request for Debiting Amounts to Account by the Direct Debit System

Date:  _______________________________

Name & Address of financial institution at which you account is held:

____________________________________________________________

____________________________________________________________

Name in full:  I/We ______________________________________________

request you until further notice in writing, to debit my/our account described in the schedule below any amount which the Australasian Meat Industry Employees' Union (067 066) may debit or charge me/us through the Direct Debit System.

I/We understand and acknowledge that:

1. The Financial Institution may, in its absolute discretion determine the order or priority of payment by it of any monies pursuant to this Request or any authority or mandate:
2. The Financial Institution may, in its absolute discretion at any time by notice in writing to me/us, terminate this Request as to future debits;
3. The user may, by prior arrangement and advice to me/us vary the amount or frequency of future debits.

Your Signature(s): ______________________________________________

____________________________________________________________

Your Address: ________________________________________________

____________________________________Postcode: ________________

THE SCHEDULE

Name on the account which is to be debited: __________________________

____________________________________________________________

BSB Number: ________________________________

Account Number: _____________________________

NOTE:  Direct Debiting is not available on the full range of accounts.  In in doubt please refer to your Financial Institution.    You must also fill out the following membership details.