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DIRECT DEBIT REQUEST _DDR_ - Defence Service Homes Insurance


									                                     DIRECT DEBIT REQUEST (DDR)
                                                                   User ID 421485
                                                         (DDR Service Agreement on reverse)
                                                                    Please use BLOCK LETTERS.
      Customer Name:        I / We ________________________________________________________
                                           Surname                                     Given names

                            authorise Defence Service Homes Insurance Scheme, to arrange for funds to be debited from
                            my/our account at the financial institution identified below through the Bulk Electronic Clearing
                            System (BECS) and as prescribed below.

                            This authorisation is to remain in force in accordance with the terms described in the Service
                Customer    ______________________________________________       ____________________________________________
 (all signatories may be
required to sign on joint   Date:    . . . / . . . / . . . .

                                                     Details of the account to be debited
                                                          (All account details must be supplied)

                            OPTION 1 - Bank Account
  Name and branch of
  financial institution:    __________________________________________________________________________

        Account name:

         BSB number:
                            |__|__|__| - |__|__|__|
     Account Number:        |__|__|__|__|__|__|__|__|__|

                            OPTION 2 - Credit Card

      Card Number           |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
         Expiry Date
                            ____/____                  CRN ____________________

 Cardholder Name            _____________________________________________________________

                                                                    Payment Details
                            Policy type : (eg contents, building) ……………………………………………………………………….

                            Policy number:    |__|__|__|__|__|__|__|__|__|
                                                          st   nd
                            Payment day(optional): (eg 1 , 2 )…………………………………………………………………………

                            Payment frequency:            Annual             Monthly
PLEASE KEEP THIS INFORMATION FOR YOUR                           5.4 If we conclude as a result of our investigations that
OWN RECORDS                                                     your account has not been incorrectly debited we will
The meaning of words printed like this in this Direct           respond to your query by providing you with reasons
Debit Request                                                   and any evidence for this finding.
Service Agreement is explained in 8 below.                      5.5 Any queries you may have about an error made in
1. Debiting your account                                        debiting your account should be directed to us in the
1.1 By signing a direct debit request, you have                 first instance so that we can attempt to resolve the
authorised us to arrange for funds to be debited from           matter between us and you. If we cannot resolve the
your account.                                                   matter you can still refer it to your financial institution
1.2 We will arrange for your financial institution to debit     which will obtain details from you of the disputed
your account in accordance with your instructions given         transaction and may lodge a claim on your behalf.
to us in the Direct Debit Request. If, however, a debit         6. Accounts
payment is due on a day:                                        6.1 You should check:
(a) which is not contained in a particular month, then the      (a) with your financial institution whether direct debiting
debit payment will be made on the last day of that              is available from your account as direct debiting is not
month; and/or                                                   available on all accounts offered by financial
(b) which is not a business day, then the debit payment         institutions;
on the next business day. If you are uncertain as to            (b) that your account details which you have provided to
when a debit payment will be processed, you should              us are correct by checking them against a recent
contact your financial institution for assistance.              account statement; and
2. Changes by us                                                (c) with your financial institution if you are uncertain
We may vary any details of this agreement or the direct         about either of the above matters before completing the
debit request at any time (including cancelling it). We         direct debit request.
will give you notice in writing of any such change at           7. Confidentiality
least fourteen (14) days before the change takes effect.        7.1 We (and our financial institution) will keep any
3. Changes by you                                               information (including your account details) in your
You may change, stop or defer a payment, or terminate           direct debit request confidential. We (and our financial
this agreement by telephoning us on 1300 552 662                institution) will make reasonable efforts to keep any
during business hours.                                          such information that we (and our financial institution)
4. Your Obligations                                             have about you secure and to ensure that any of our
4.1 It is your responsibility to ensure that there are          employees or agents who have access to information
sufficient clear funds available in your account to allow       about you do not make any unauthorised use,
a debit payment to be made in accordance with the               modification, reproduction or disclosure of that
direct debit request.                                           information.
4.2 If there are insufficient clear funds in your account to    7.2 We will only disclose information that we have about
meet a debit payment:                                           you:
(a) you may be charged a fee and/or interest by your            (a) to the extent specifically required or authorised by
financial institution;                                          law; or
(b) you may also incur fees or charges imposed or               (b) for the purposes of this agreement (including
incurred by us; and                                             disclosing information in connection with any query or
(c) you must arrange for the debit payment to be made           claim); or
by another method or arrange for sufficient clear funds         (c) with your implied or express consent.
to be in your account by an agreed time so that we can          8. Definitions
process the debit payment.                                      account means the account held at your financial
4.3 You should check your account statement to verify           institution from which we are authorised to arrange for
that the amounts debited from your account are correct.         funds to be debited.
5. Dispute                                                      agreement means this Direct Debit Request Service
5.1 If you believe that there has been an error in              Agreement between you and us.
debiting your account, you should notify us immediately         business day means a day other than a Saturday or a
by contacting us on 1300 552 662. Before you make the           Sunday or a public holiday listed throughout Australia.
call, make sure you have all the relevant documentation         debit payment means a particular transaction where a
available.                                                      debit is made.
5.2 We will investigate and deal promptly and in good           direct debit request means the Direct Debit Request
faith with any such query, claim or complaint. If your          between us and you.
query, claim or complaint cannot be resolved to your            our financial institution means the financial institution
satisfaction in that call, we will inform you at that time of   that we contract to process your debit payment.
the length of time which we estimate the investigation          us, we or our means Defence Service Homes
will take.                                                      Insurance.
5.3 If we conclude as a result of our investigations that       you means the person(s) who signed the direct debit
your account has been incorrectly debited we will adjust        request.
your account accordingly by directly crediting your             your financial institution means the financial
account or sending you a refund cheque at our                   institution where you hold the account that you have
discretion. We will also notify you of the adjustment           authorised us to debit
either orally or in writing.

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