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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 Agreement. Customer ______________________________________________ ____________________________________________ signature(s): (all signatories may be required to sign on joint Date: . . . / . . . / . . . . accounts) 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.
"DIRECT DEBIT REQUEST _DDR_ - Defence Service Homes Insurance"