Page 88 - Signature Funeral Directors Book for Adelaide 2017

Application Form No. 1 (cont.)
Step 7 Regular savings plan (Direct debit request)

Dear Sir/Madam,
I authorise my monthly direct debit from my/our account detailed below to commence on the 15th day of the next month or to commence
in the month of

The Schedule – details of the account to be debited
Name of Financial Institution

Address of Branch
Town/Suburb State Postcode

Account Name
Branch No. (BSB) Account No. (The account to be debited cannot be a
credit or debit card number or account)
(must complete all 6 digits) (must be no more than 9 digits)

I/We (Surname)

(Given Names)
I/We (Surname)

(Given Names)
Request and authorise the Australian Friendly Society Limited with user ID number 203654 to arrange, by its own financial institution, a
debit to your nominated account any amount the Australian Friendly Society Limited, has deemed payable to you.
This debit or charge will be made through the Bulk Electronic Clearing System (BECS) from your account held at the financial institution you
have nominated above and will be subject to the terms and conditions of the Direct Debit Service Agreement.
Investment details
I wish the total amount of my Bond to be $ .

Please note that this amount includes any initial contribution (as per Step 2) or additional contributions and the contribution fee of 2%
(if applicable) but excludes bonuses paid and the cost of the Travel Protection Plan if this option is chosen.

Please debit $ . per month, including 2% contribution fee (if applicable) from the account detailed above.

Please indicate if this amount includes a contribution fee Yes No
(Please note a minimum of $42 per month. If a 2.00% contribution fee applies, the minimum is $42.84. Also you may not wish total
contributions to exceed the social security threshold limit – if entitled to receive a means-tested pension or other Government benefit.
Refer to page 12)
The regular savings plan (Direct debit request) cannot be used for one-off transactions.

By signing and/or providing us with a valid instruction in respect of your Direct Debit Request you have understood and agreed to the
terms and conditions governing the debit arrangements between you and the Australian Friendly Society Limited as set out in this Request
and in your Direct Debit Service Agreement.

Investor 1 Signature Date / /

Investor 2 Signature Date / /

To be signed by Date / /
account holder(s) if
different to investor

If joint investors are applying then both applicants are required to sign.

If you are signing the application form under a power if attorney, a certified copy of the power of attorney must be enclosed with the
application form. Please note that the Society is unable to accept a photocopy of a certified document, or a verified document.

ALL SECTIONS MUST BE COMPLETED

Bendigo Funeral Bond
Application form