Direct Debit Form

Direct Debit Form
I/We request Uninor (User ID 314572) to consolidate funds to be debited from my/our nominated account
at the financial institution as per schedule below. This debit or charge will be made through the Bulk Electronic Clearing
System (BECS) through your account held at the financial institution nominated below and will be subject to the terms
and conditions of the Direct Debit Request Service Agreement.
New Customer (Telephone #):
Existing Customer (Account#):
Customer Name:
Phone Number:
Address:
Email:
Schedule: Payments will be debited on the due date. If the scheduled date is not a banking day, the debit will
take place on the next banking day.
Option 1: Bank Account Details
Note: Direct Debiting is not available on all accounts. If in doubt, refer to your financial institution.
Bank Name:
Branch:
Account Name:
BSB:
Account:
I/We acknowledge that this Direct Debit facility is governed by the terms of the Direct Debit Service arrangement
received from Uninor.
1. Signature(s)
2. Signature(s)
and Date
and Date
Option 2: Credit Card Details
Visa
Name on the card:
Master Card
Card number:
Expiry date:
AMEX
Customer's Signature
Date
ACKNOWLEDGEMENT
I/We have read the Direct Debit Service Agreement attached and agree to its terms. I/We request that this Direct
Debit Request remain in force until cancelled, deferred or otherwise altered in accordance with the Direct Debit Request
Service Agreement. I/We confirm the account/credit card details set out above, are correct and that this Direct Debit
Request is signed by the number of authorised signatories required by the financial institution where my/our account is
held.
Customer's Signature
Date
Completed Application: Return your completed
application by mail to: - PO Box 2505, Taylors Lakes, VIC,
3038.
Customer Direct Debit Request (DDR) Service Agreement:
This is your Direct Debit Service Agreement with Uninor
(314572). 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 this 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.
Debiting your account: 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.
We will only arrange for funds to be debited from your
account as authorised in the Direct Debit Request.
or
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.
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.
Amendments by us: 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.
Amendments by you: You may change, stop or defer a
debit payment, or terminate this agreement by providing
us with at least seven (7) days notification by writing to:
PO Box 2505, Taylors Lakes, VIC, 3038 or by telephoning us
on 1300 193 310 during business hours; or arranging it
through your financial institution, which is required to act
promptly on your instructions.
Your obligations: 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. If there are insufficient clear
funds in your account to meet a debit payment:
- you may be charged a fee and/or interest by your
financial institution;
- you may also incur fees or charges imposed or incurred
by us; and
- 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.
* You should check your account statement to
verify that the amounts debited from your account are
correct.
If you believe that there has been an error in debiting your
account, you should notify us directly on 1300 193 310 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.
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.
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.
Accounts:
You should check:
- 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.
- your account details which you have provided
to us are correct by checking them against a recent
account statement; and
- 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.
We will only disclose information that we have about you:
- to the extent specifically required by law; or
- for the purposes of this agreement (including disclosing
information in connection with any query or claim).
Notice: If you wish to notify us in writing about anything
relating to this agreement, you should write to:
Uninor Pty Ltd
PO Box 2505, Taylors Lakes, VIC,
3038
We will notify you by sending a notice in the ordinary
post to the address you have given us in the Direct Debit
Request.
Any notice will be deemed to have been received on the
third banking day after posting.
HOW TO CONTACT US
Enquiries You can contact us directly or alternatively
contact your financial institution. These should be
made at least 7 working days prior to the next
scheduled drawing date.
You may contact us on
Phone: 1300 193 310
Email: [email protected]
Mail: PO Box 2505, Taylors Lakes, VIC,
3038
Please include your Customer Number in all
communication sent.