DIRECT DEBIT REQUEST ABN 20 903762 572 RATES ENQUIRIES Telephone: 8203 7242 Email: [email protected] Request and Authority to debit the account nominated below to pay: CORPORATION OF THE CITY OF ADELAIDE Request and Authority to Debit This debtor charge will be made through the Bulk Electronic Clearing System (BECS) from your account held at the financial institution you have nominated below and will be subject to the terms and conditions of the Direct Debit Request Service Agreement. Surname/Company Name Given Names/ABN I request and authorise the CORPORATION OF THE CITY OF ADELAIDE (User ID 440688) to arrange through its own financial institution, a debit to the account I have nominated any amount the CORPORATION OF THE CITY OF ADELAIDE has deemed payable by me. Applicant Details Assessment Number * Who is Applying? * Owner Other Specify Other Contact Phone Number * Email Address * Property Address * Debit Account Nomination I nominate the following account to be debited Financial Institution Name _ Address _ _ Account Name _ -- BSB Number (Must be six digits) Account Number Payment Details Please select one of the options below (Quarterly amounts will be debited the Friday before falling due) Annually Amount as per Rates Notice Quarterly Amount as per Rates Notice Instalment due dates as per Rates Notice Monthly $ Last Friday of each Month Payment Start Date Please indicate the date you wish debits to begin D D / M M / Y Y By signing and providing us with a valid instruction in respect to your Direct Debit Request, you have understood and agreed to the terms and conditions governing the debit arrangements between you and the Corporation of the City of Adelaide as set out in this Request and in your Direct Debit Request Service Agreement. Signed Print Name Date / / Signed Print Name Date / / This is your Direct Debit Service Agreement with the Corporation of the City of Adelaide, 440688 & 20 903 762 572. It explains what your obligations are when undertaking a Direct Debit arrangement with us. It also details what our obligations are to you as your Direct Debit provider. Please keep the copy of the agreement for future reference. It forms part of the terms and conditions of your Direct Debit Request (DDR) and should be read in conjunction with your DDR authorisation. Definitions 4.2 account means the account held at your financial institution from which we are authorised to arrange for funds to be debited. agreement means this Direct Debit Request Service Agreement between you and us. banking day means a day other than a Saturday or a Sunday or a public holiday listed throughout Australia. If there are insufficient clear funds in your account to meet a debit payment: (a) you may be charged a fee and/or interest by your financial institution; (b) you may also incur fees or charges imposed or incurred by us; and (c) you must arrange for the debit payment to be made by another method or arrange for sufficient clear funds to be in your account by an agreed time so that we can process the debit payment. debit day means the day that payment by you to us is due. debit payment means a particular transaction where a debit is made. direct debit request means the Direct Debit Request between us and 4.3 you. You should check your account statement to verify that the amounts debited from your account are correct us or we means the Corporation of the City of Adelaide, (the Debit User) you have authorised by requesting a Direct Debit Request. 5 Dispute 5.1 If you believe that there has been an error in debiting your account, you should notify us directly on 8203 7203 and confirm that notice in writing with us as soon as possible so that we can resolve your query more quickly. Alternatively you can take it up directly with your financial institution. 5.2 If we conclude as a result of our investigations that your account has been incorrectly debited we will respond to your query by arranging for your financial institution to adjust your account (including interest and charges) accordingly. We will also notify you in writing of the amount by which your account has been adjusted. you means the customer who has signed or authorised by other means the Direct Debit Request. your financial institution means the financial institution nominated by you on the DDR at which the account is maintained. 1. Debiting your account 1.1 By signing a Direct Debit Request or by providing us with a valid instruction, you have authorised us to arrange for funds to be debited from your account. You should refer to the Direct Debit Request and this agreement for the terms of the arrangement between us and you. 5.3 1.2 We will only arrange for funds to be debited from your account as authorised in the Direct Debit Request. or 6. We will only arrange for funds to be debited from your account if we have sent to the address nominated by you in the Direct Debit Request, a billing advice which specifies the amount payable by you to us and when it is due. 1.3 Amendments by us 2.1 We may vary any details of this agreement or a Direct Debit Request at any time by giving you at least fourteen (14) days written notice. 3. Amendments by you 3.1 You may change*, stop or defer a debit payment, or terminate this agreement by providing us with at least fourteen (14 days) notification by writing to: 7. arranging it through your own financial institution, which is required to act promptly on your instructions. *Note: in relation to the above reference to ‘change’, your financial institution may ‘change’ your debit payment only to the extent of advising us the Corporation of the City of Adelaide your new account details, 4. Your obligations 4.1 It is your responsibility to ensure that there are sufficient clear funds available in your account to allow a debit payment to be made in accordance with the Direct Debit Request. with your financial institution whether direct debiting is available from your account as direct debiting is not available on all accounts offered by financial institutions. (b) your account details which you have provided to us are correct by checking them against a recent account statement; and (c) with your financial institution before completing the Direct Debit Request if you have any queries about how to complete the Direct Debit Request. Confidentiality We will keep any information (including your account details) in your Direct Debit Request confidential. We will make reasonable efforts to keep any such information that we have about you secure and to ensure that any of our employees or agents who have access to information about you do not make any unauthorised use, modification, reproduction or disclosure of that information. 7.2 We will only disclose information that we have about you: (a) by telephoning us on 8203 7203 during business hours; Or (a) 7.1 Rates and Valuation Services Adelaide City Council GPO Box 2252 ADELAIDE SA 5001 Or Accounts You should check: If the debit day falls on a day that is not a banking day, we may direct your financial institution to debit your account on the following banking day. If you are unsure about which day your account has or will be debited you should ask your financial institution. 2. If we conclude as a result of our investigations that your account has not been incorrectly debited we will respond to your query by providing you with reasons and any evidence for this finding in writing. to the extent specifically required by law; or for the purposes of this agreement (including disclosing information in connection with any query or claim). 8. Notice 8.1 If you wish to notify us in writing about anything relating to this agreement, you should write to : Rates and Valuation Services Adelaide City Council GPO Box 2252 ADELAIDE SA 5001 8.2 We will notify you by sending a notice in the ordinary post to the address you have given us in the Direct Debit Request. 8.3 Any notice will be deemed to have been received on the third banking day after posting.
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