Direct Debit Application Form

Australian Education Union Tasmanian Branch
Direct Debit Application Form
Name
Workplace
Mobile
Alternative email address
I authorise the Australian Education Union Tasmanian Branch to use the above details in communicating
with me. We guarantee this information will not be provided to a third party. (please tick)
Method 1: Direct Debit (preferred)
Name of customer making this direct debit request: I, (full name)
request and authorise the Australian Education Union – Tasmanian Branch (Debit User ID 312154) to arrange through its own financial institution a debit to my nominated
bank account (as detailed), of funds as determined by AEU Branch Council according to AEU Rules, through the Bulk Electronic Clearance System (BECS). This authorisation
is to remain in force in accordance with the Direct Debit Service Agreement as set out below.
Name of Financial Institution
Branch
BSB No
Account Number
Account Name
Frequency of Deduction:
Signature and Date
Fortnightly
Monthly
Quarterly
Half-Yearly
/
Annually
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Direct Debit Request Service Agreement
The following is your Direct Debit Request Service Agreement with The Australian Education Union – Tasmanian Branch, ABN 33 937 425 345 & User ID 312154. The agreement is designed to explain 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. We recommend you keep this agreement in a safe place 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 form.
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. | 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 you. | Us or we means The Australian Education Union – Tasmanian Branch, (the Debit User) you have authorised by signing a direct debit request. | You
means the customer who signed 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. By signing a Direct Debit Request, 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 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. 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.
3. Amendments by you – 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: The Australian Education Union – Tasmanian
Branch or by telephoning us on (03) 6234 9500 during business hours or arranging it through your own financial institution.
4. Your obligations. 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 The Australian Education Union – Tasmanian Branch is liable to pay goods and services tax (“GST”) on a supply made in connection with this agreement, then you agree to
pay The Australian Education Union – Tasmanian Branch on demand an amount equal to the consideration payable for the supply multiplied by the prevailing GST rate.
5. Dispute. If you believe that there has been an error in debiting your account, you should notify us directly on (03) 6234 9500 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 with your financial institution direct. 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.
6. Accounts. You should check:(a)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.
7. 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:(a)to the extent specifically required by law; or (b) for the purposes of this agreement (including disclosing information in connection with any query or claim).
8. Notice. If you wish to notify us in writing about anything relating to this agreement, you should write The Australian Education Union – Tasmanian Branch. 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.
Method 2: Credit Card
Card Number
Expiry Date
Name as it appears on your card
Frequency of Deduction:
Fortnightly
Monthly
Signature and Date
Quarterly
Half-Yearly
Annually
For additional payment methods such as BPay® please contact the
membership team at the Australian Education Union on 1800 000 313.
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Please return this form to:
AEU, Reply Paid 117, NORTH HOBART TAS 7002