Page 92 - Signature Funeral Directors Book for Adelaide 2017
P. 92

Application Form No. 2 (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
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