Periodical Payment T 1300 655 116 F 02 9965 1222 P Locked Bag 7003 Concord West NSW 2138 E
[email protected]
ABN 59 087 650 584 AFSL 246941
Personal details Member number
Contact number
Member name(s) Create a new payment authority
I/we want to:
From account
Amount
Alter an existing payment authority
Delete an existing payment authority
Member number and account (S1, S3 etc)
$
Frequency
Weekly
First payment date
Transfer funds to
/
Fortnightly
/
4 weekly
Last payment date
Monthly
/
/
Once only
or
until further notice
the following My Credit Union account: Name
Member number and account (S1, S3 etc)
the following BPAY account: Biller name
Biller code
Customer reference number
the following external account: Financial institution name
BSB
Account number
Warning: You must ensure that the Biller code and Reference are correct or your payment may be unsuccessful or may be paid to an unintended account. If you pay monies to an unintended account, you may be liable for the loss if the funds are unable to be retrieved from the biller. Note the receiving biller may not validate the account name and may rely solely on the reference number. BPAY transactions requested before 3:00pm (AEST) on a Banking Business Day will be sent to the biller on the same day. BPAY transactions requested after this time may be sent on the next Business Banking Day. When the biller will receive the payment depends on the policy and systems of the biller’s bank, however they are generally received within 1 - 2 business days. Warning: You must ensure that the BSB and account number are correct or your payment may be paid to an account that does not belong to the named recipient. If the payment is made to an incorrect account it may not be possible to recover the funds from the unintended recipient. Note the receiving bank may not validate the account name and may rely solely on the BSB and account number.
Account name
Member authority I/we agree to be bound by the Conditions of Use for this facility. I/we understand that payments under this authority will not be made unless sufficient clear funds are available in your nominated savings account on the due date. Member 1 signature
Date
/
/
Member 2 signature
Date
/
/
Note: This authority must be signed in accordance with the membership signing authority Branch use only Member 1 sig verified Member 2 sig verified
Completed by Op No.
Authority number Date
/
/ F024_1 09/14
