Payroll Deduction (before tax)

Payroll Details

First Name *

Last Name *

Email Address *

Deduction Details

Date effective from

Payee

Client/Member # (if applicable)

Amount per pay ($)

Name of bank or financial institution

Account name

BSB

Account number

Please double-check the account details are correct before submitting this form.
It is the responsibility of the individual to ensure the details supplied to the Registry are correct.

Authorisation

Cancellation

I request and authorise the Bendigo Anglican Diocesan Corporation to make the above deduction from my pay before tax

I request and authorise the Bendigo Anglican Diocesan Corporation to cancel the above deduction from my pay before tax

Signature *

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Date *