Commonwealth Consolidated Regulations Commonwealth Consolidated RegulationsNote: See subregulation 28LCE(2).
[Form] Consent to make direct deductions from salary or wages
Subsection 160E(2) of the Act
[Regulation 28LCE of the Regulations]
TO: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(name of employer of debtor/lessee)
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(address of employer of debtor/lessee)
FROM: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(name of credit provider/lessor)
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(Australian credit licence number)
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(address of credit provider/lessor)
Complete all of the following information (except as indicated) before signing the form
Date of first deduction:
Date of last deduction:
Amount of each deduction:
IMPORTANT YOU CAN CANCEL THIS DEDUCTION REQUEST DIRECTLY WITH YOUR EMPLOYER AT ANY TIME. IF YOU CANCEL THIS DEDUCTION REQUEST YOU WILL BE IN DEFAULT IF YOU DO NOT MAKE ALTERNATIVE ARRANGEMENTS TO MAKE REPAYMENTS. |
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(signature of debtor/lessee giving consent)
I confirm I have been provided with a copy of this form.
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(signature of debtor/lessee giving consent)
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Date of signing
The following information is optional
INFORMATION TO THE EMPLOYER These arrangements relate to a contract between your employee and a third party. You are not liable for any failure of your employee to make payments to that person. Your employee may ask you to cancel these arrangements at any time or may vary them by completing a new form. |
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(signature of employer)
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Date of signing
IMPORTANT
We have not received a payment because your arrangements to pay by direct debit have been dishonoured .
IMPORTANT
You are in default of your credit contract because you have not made a payment [ alternative wording can be used if the default is not the result of failing to make a payment ].
IMPORTANT
We have not received a payment because your arrangements to pay by direct debit have been dishonoured .
IMPORTANT
You are in default of your consumer
lease contract because you have not made a payment [ alternative wording can
be used if the default is not the result of failing to make a payment ].