Payment Plan Enrolment Form by rgi48072


									                             Payment Plan Enrolment Form
                        FNS60404 Advanced Diploma of Financial Services (Financial Planning)
                                                                                                                         Administration use only
Please complete this form and fax to: 1300 794 820                                                             Pin number                     Date received
Alternatively, email it to:

 1. Personal information

 Title     Mr        Miss       Mrs        Ms         Dr   
 First name                                                                    Surname

 Are you an existing student?       No  Yes                  Have any of your enrolment/contact details changed?            No  Yes
 Employer                                                                      Licensee name

 2. Advanced Diploma course enrolment information

When enrolling in all the modules that make up the full Advanced                   When enrolling into individual modules use Option 2 to tick only
Diploma program at the same time, only tick the Full Advanced                      the individual subjects in which you would like to enrol.
Diploma Enrolment (Option 1).
                                                                                   *To be eligible for a payment plan, your enrolment must be to be to the
                                                                                   value of at least $750.

                                                                              Enrolment distance                     Modules to be sent now
 Option 1: Full Advanced Diploma enrolment
 Full Advanced Diploma enrolment                                                          $1728                         ADEP                  ADTX 
 Plus Postage and Handling                                                                 $60                           ADIN                 ADSA 
 A - Total                                                                                $1788
 B - Payment plan monthly charge = A (Total) / 7.5                                        $238                        Note: The modules selected will be
                                                                                                                        sent now. When you are ready to
 C - Payment plan up-front charge = B (monthly charge) x 2                                $476                      receive the remaining modules in your
                                                                                                                       enrolment, simply call or email us.

                                                                              Enrolment distance                    Modules to be sent now
 Option 2: Individual module enrolments
 (ADEP) Advanced Estate Planning                                                   $480                               ADEP                  ADTX 
 (ADTX) Advanced Taxation and Superannuation                                       $480                                ADIN                 ADSA 

 (ADIN) Advanced Investment Planning                                               $480               
 (ADSA) Advanced SOAs and Practice Management                                      $480               
 Postage and handling ($15 per module)                                                                              Note: The modules selected will be sent
                                                                                                                    now. When you are ready to receive the
 A - Total                                                                         $                                 remaining modules in your enrolment,
                                                                                                                            simply call or email us.
 B - Payment plan monthly charge = A (Total) / 7.5                                 $
 C - Payment plan up-front charge = B (monthly charge) x 2                         $

Note: Under the payment plan, the up-front charge (“C”) is payable on enrolment, and the monthly charge (“B”) is payable on the 15th of the month for each of
the following six months. The total fees payable under the payment plan is the total of the upfront payment (“C”) and the six monthly payments (“B”).

                       Pinnacle Financial Services Academy Pty Ltd RTO Provider Number: 91217 // ABN: 74 116 541 256
                 Sydney Level 2, 140 William Street, Potts Point, NSW 2011 Melbourne 68-72 York Street, South Melbourne, Vic 3205
                                            General Enquiries Phone 1300 782 822 // Fax 1300 794 820
FM_AD_Payment_Plan_v090907                                            Page 1 of 2
 3. Enrolment and course material delivery terms

Please direct any queries concerning completion of this form to a client               The delivery address provided must be a physical address, and not a post
service coordinator on 1300 782 822. Pinnacle will send module materials               box, at which a person who is authorised and willing to sign for receipt of
to the address indicated on this enrolment form. It is the student’s                   materials will be available during business hours.
responsibility to notify Pinnacle of any changes to address or contact details
throughout the enrolment period.                                                       Pinnacle’s delivery obligations are complete when an attempt has been
                                                                                       made to deliver at the address provided during business hours. Further fees
Students can nominate the number of modules they would like to receive                 will be payable if delivery was not completed due to the provision of a wrong
when the enrolment is initially processed. If a student chooses not to                 address, or where a person was not available to take delivery during
receive all modules initially, it will then become their responsibility to contact     business hours.
Pinnacle to order subsequent modules. Students should email Pinnacle at stating their full name, PIN number and current               Students are bound by the current terms and conditions outlined within the
address details when ordering the additional module material.                          Student Information Guide.

The pricing published on this page does not include international postage.
Students requiring international postage will incur additional postage costs.
Please contact a customer service coordinator for further information.

 4. Payment plan rules

Students are only eligible for the payment plan if they undertake studies to           If a monthly payment is outstanding without prior alternative arrangements
the value of at least $750 in any one enrolment (“A”).                                 confirmed with Pinnacle, educational services will be suspended. This
                                                                                       includes access to learning and assessment systems, new course material,
Upon enrolment, Pinnacle requires two of the eight instalments to be paid              student services and marking of assessments.
immediately up front (“C”). Six consecutive monthly payments (“B”) will be
payable on the 15th of each month, commencing in the month following the               If you wish to make adjustments to your payment schedule, such as
month of initial enrolment. Payments will be debited to your nominated debit           increasing your monthly instalments, making a once-off payment to finalise
card or Mastercard or Visa credit card.                                                fees, making an earlier payment or other alternative arrangements then
If a scheduled payment is unsuccessful, you will receive notification by
email and a failed payment fee of $13.84 will apply. If the email notification         No qualifications, Statements of Attainment or Certificates of Completion
bounces back, an SMS will be sent to your mobile telephone. A second                   will be issued until all payments have been received in full.
attempt to debit your account will be made 14 days after the failed attempt,
and the amount debited will include the failed payment fee. If this second             You may change bank or credit card details once the payment plan has
attempt is unsuccessful, another failed payment fee of $13.84 will apply and           commenced     by    contacting    us     on    1300     782 822   or
another attempt will be made in approximately 14 days.                        to request the appropriate form.

 5. Student services information
Do you have any special learning or assessment needs that need to be taken            Are you applying for Recognition of Competency (ROC)?
into account to support your learning?
                                                                                      If you have extensive experience or qualifications you may be eligible for
 No                    Yes please call me to discuss                                ROC, which exists for students who can demonstrate work experience or
                                                                                      previous training/qualifications relevant to the module or the Advanced
                                                                                      Diploma as a whole. Pinnacle offers the following ROC pathways:
(If yes, please complete a separate ROC application form)
                                                                                      1) Mutual Recognition

                                                                                      2) Credit Transfer

                                                                                      3) Recognition of Prior Learning (RPL)

                                                                                      4) Customised Recognition

                                                                                       No                     Yes
                                                                                      (If yes, please complete a separate ROC application form)

 6. Declaration

I declare that I have read, understood and will comply with the                       I agree that Pinnacle has the right to refuse any application for any reason at
requirements of Pinnacle’s Student Information Guide, Privacy Policy, and             its absolute discretion, and also has the right to terminate any enrolment
Course Material Delivery terms.                                                       without refund where a student engages in plagiarism or any other form of
I understand that some assessment tasks are completed online. I have                  cheating.
reliable access to the internet.
                                                                                      Pinnacle may pass on the details of any such behaviour to financial services
The information I have provided is true and correct.                                  or training industry regulators, industry bodies including the Financial
The information I have provided may be shared with third parties, but only            Planning Association of Australia and any AFSL holder who employs or
in accordance with the requirements of Pinnacle’s Privacy Policy and the              authorises or is considering the employment or authorisation of the student
Australian Quality Training Framework (AQTF).                                         to provide financial services product advice.

Signature:        ______________________________________                              Date:                ____ / ____ / ___

FM_AD_Payment_Plan_v090907                                                      Page 2 of 2                                     Pinnacle Financial Services Academy
                                                  TERMS AND CONDITIONS
Direct Debit Authority

I/we acknowledge and/or authorize:
• Ezypay to make periodic debits from my/our account on behalf of the Company (herein referred to as the Principal)
    stated on the front of this Direct Debit Request Form.
• If the Principal authorises as such, you will be required to pay Ezypay’s load and commission fees.
• That Ezypay is acting as a direct debit agent for the Principal only and does not provide any goods or services to me/us and has no express
    or implied liability in regard to the goods and services provided by the Principal. As such, Ezypay also has no liability to provide any tax
    invoices for any fees charged.
• That the periodic debiting of my/our account will be in accordance with the payment arrangement outlined in Section B, with the Terms and
    Conditions outlined herein and any variations made to them from time to time, as well as the terms and conditions between Ezypay and the
• Ezypay to communicate with me/us by phone, email or mail to effectively manage my/our account.
• Ezypay to vary these Terms and Conditions from time to time and I acknowledge that it will be sufficient for Ezypay to notify me/us of such
    changes by posting them on Ezypay’s website:
• It is my/our responsibility to check Ezypay’s website for variations to these Terms and Conditions and I/we will not require Ezypay to inform
    me of such changes by any other means of communication including but not limited to, written notice, phone or email.
• Any variations made to these Terms and Conditions will be effective 14 days after posting on Ezypay’s website.
• Ezypay may terminate this Direct Debit Request and cease to provide its direct debit services to me/us at any time by written notice sent by
    mail or email, such notice to state the reason for the termination.

Variations to My/Our Direct Debit Arrangement

    I/we acknowledge and/or authorize:
•   The Principal to vary the amount, frequency and date of payments from time to time.
•   Ezypay to vary the payments upon instructions from the Principal. I/we do not require Ezypay to notify me/us of such variation prior to
    varying the debit amount.
•   All other variations to my/our debit arrangement will need to be directed to the Principal. Ezypay can only process variations to my/our direct
    debit arrangement upon the Principal’s instructions and where those instructions are received, Ezypay will not require a signed agreement or
    new Direct Debit Request Form from me/us.
•   Ezypay will make reasonable attempts to minimize any variance to debit amounts affected by exchange rate fluctuations or factors in
    connection with the provision of the direct debit service that are within Ezypay’s control. However, Ezypay will not be responsible for any
    variance or shortfall to debit amounts affected by exchange rate fluctuations as a result of external factors beyond the control of Ezypay
    including but not limited to, the date on which a direct debit is processed by Ezypay’s Sponsoring Financial Institution, the timing a debit is
    requested and processed or where there is a delay in the processing of a direct debit due to any one of the factors (a) to (c) specified below.
•   That a delay may occur in the processing of a direct debit if:
    (a) There is a public or bank holiday on the day or on the day after a payment is due to be made by direct entry;
    (b) A payment is received either on a day, which is not a banking business day, or after the normal close of business on a business banking
    day; or
    (c) Ezypay does not receive the Direct Debit Request Form so that it has sufficient time to process the Direct Debit Request Form prior to
    the first debit payment being due and payable.

My Responsibility

 I/we acknowledge that:
• It is my/our responsibility to inform Ezypay or the Principal of any changes to my account or contact details (by phone, mail or email) to
    permit and facilitate the direct debit arrangement as per these agreed Terms and Conditions.
• It is my/our responsibility to have sufficient funds available in my/our account failing which I/we will incur a failed payment fee of up to $16.50
    for each unsuccessful debit, in addition to any fees charged by my/our Financial Institution, and any collection fees incurred by Ezypay
    including but not limited to any legal costs and/or the commission of a collection agent appointed by Ezypay for the purpose of recovering
    the unsuccessful debit payment. Additionally, Ezypay in conjunction with the principal will implement re-debit measures as necessary to
    recover any outstanding amount/s.
• For the avoidance of doubt, Ezypay will not be liable for any fees or charges described in the above paragraph.
• Ezypay requires a 7 days written notice should I/we wish to cancel this direct debit arrangement. On receiving such notice, Ezypay will have
    the authority to direct debit any payments due within the 7 days notice period and thereafter, cancel the direct debit arrangement as
    requested by me/us. The cancellation will be effective 7 days after the notice has been received.
• Any cancellations made directly with Ezypay do not affect or terminate any contracts, agreements or payment obligations I have with my Principal.
• I may be charged fees if my Principal authorises as such for account setup/maintenance.
• Any disputed debit item/amount should be directed to the Principal.

Servicing My Account

I/we acknowledge and/or authorize the following:
   (a) Ezypay to verify the details of my/our account with my/our Financial Institution.
   (b) My/our record and account details may be required by my Financial Institution in connection with a claim made on it relating to an alleged
   incorrect or wrongful debit.
   (c) My/our Financial Institution to release information allowing Ezypay to verify my/our bank account details.
   (d) Ezypay may inform me of products, services or special offers relating to the provision of its direct debit service and other related financial
   service products.
   (e) Ezypay is not liable for any faults in the direct debit of my/our account caused by, but not limited to, events such as fraudulent activity,
   security hacking, and environmental disasters. Due to the technology systems used by Ezypay to facilitate the direct debiting, Ezypay is not
   able to and does not give an express or implied warranty that any direct debit service it provides will be continuous or fault free.

I/we acknowledge that the Ezypay Pty Limited Privacy Policy can be found at

                           EZYPAY PTY LTD - Locked Bag 4003, Chatswood NSW 2057
                                                           a x 02 9410 1 5 4 9
                             Telephone e130003000553 3 FFax 0 2 9 4 1 0 1000
                              Te l e p h o n 1 3 0 3 0 5 5
                                Direct Debit Request Form - new customers only
                                Please use BLACK (Preferable) / BLUE BALL POINT PEN. * Compulsory field

Your Reference ID
for this Customer:

Company Name:

* First Name:

* Surname:

* Date of Birth:                          .            .                                                                      Password:

* Address Line 1:

Address Line 2:

* Suburb:                                                                                                                                  * State:                       * P/C:

* Phone (M):                                                                                                                   Phone:

* Email:

                                                                                                                     Fees and charges may apply.
Section B - PAYMENT INSTRUCTION                                                           IMPORTANT                  Please allow 5 working days for processing after the form is received by Ezypay

1)    First debit or once off debit                                  $                                 .                    To be debited on:
                                                                                                                                                                   .            .
Regular                                                         To be debited                                                             Starting
amount     $                                  .                 every:
                                                                                               Month(s) or                  Week(s)
                                                                                                                                          on:                      .            .
3) Optional
                                                                  Debits will                              End after this                                                       Debits will continue
on:                     .             .                           continue if no end
                                                                  date is specified
                                                                                              OR           total amount
                                                                                                           is collected:
                                                                                                                            $                                 .                 if no total amount
                                                                                                                                                                                figure is specified
                                                                                                           Note : This total amount collected option needs to be pre-organised with EZYPAY

Section C - PAYMENT METHOD (please select Bank Account or Credit Card)
Name of Institution
e.g.("Commonwealth Bank"):

Suburb where branch is located:

Name of Account Holder(s):

BSB Number:                                                            -                                                Account Number:

     I / we authorise Ezypay Limited APCA User ID Number 064323 to debit my / our accounts at the Financial Institution identified above through the Bulk Electronic Clearing System (BECS)

CREDIT CARD                               Select your card type:              VISA                  MASTERCARD                             AMEX                    DINERS

Card Number:                                                                                                                        Expiry Date:                   .
Name on Card:

     This authorisation is to remain in force in accordance with the Terms and Conditions on this                                                                 DO NOT MARK THIS BOX
     page and on the reverse side which I/we have read and understood.                                                                                            EZYPAY REFERENCE NO

1.                                                    2.                                                               .             .
     Signature of cardholder(s) or acount holder(s)

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