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Print Post lodgement document - Australia Post

Print Post lodgement document - Australia Post

Print Post lodgement document - Australia

Print Post mailing statement For delivery within Australia Do not include on this form items for External Territories. Refer to the Supplementary Statement for External Territories Form 8838499 Customer details Please advise your State Print Post Co-ordinator if any of these details have changed since your last lodgement. Name of Publisher (or Distributor) Address Contact name Telephone number Email Payment method: Weight of each copy in grams Lodgement date / / Customer reference number Statement number Name of facility where lodging mail Fax number ( ) Postcode Name of mailing agent authorised by the customer (if applicable) Mailing agent contact name Publication details Full title of publication Print Post Publication Number Cash Postage meter Australia Post Business Credit Account Mailing agent telephone number Size of article (tick appropriate box) Small Large 250g 450g 650g 850g 0–250g 50g 300g 500g 700g 900g 125g 350g 550g 750g 950g 175g 400g 600g 800g 1kg Number of articles in: LPD SPD Residue Totals Same State Metro Country Residue Other State Metro Country Residue Local Sort Division Totals LPD = Large Postcode Direct SPD = Small Postcode Direct • Original - Australia Post • Duplicate - Customer copy of Privacy notice Your personal information is collected only to enable us to provide you with the products/ services you wish us to provide. The products/services may not be able to be provided without this information. You may request access to your personal information while it is stored by us and we will assess your request in accordance with the law. We will give you reasons where we deny access. Call 13 11 18 to contact us. Declaration I hereby warrant and declare that: 1. I am authorised by the Customer to complete this Mailing Statement and lodge articles for delivery by Australia Post using the Print Post service. 2. I have read and (to the extent terms are not otherwise agreed by the Customer and Australia Post), on behalf of the Customer, I agree to the Print Post service terms and conditions as printed on the reverse of this Mailing Statement. 3. All information that has been completed on behalf of the Customer in this document is, to the best of my knowledge, true and correct. 4. Articles lodged with this Mailing Statement do not contain dangerous or prohibited goods such as explosives, flammables, corrosives and aerosols. (If there is any doubt as to what is a dangerous or prohibited good ask at any Australia Post retail outlet or check the Australia Post website.) I Acknowledge and Agree on behalf of the Customer that: 1. Australia Post will have accepted this lodgement only when the Mailing Statement is correctly receipted and stamped. 2. Receipt, carriage and/or delivery by Australia Post of any articles accompanying this Mailing Statement will not mean that Australia Post has agreed that the articles are eligible for carriage at the Print Post rates of postage. 3. Not withstanding that the articles have been lodged, Australia Post may determine at any stage that the articles are not eligible for carriage at the Print Post rates of postage, in which case postage shall be assessed at the appropriate higher rate. The Customer will pay any such additional postage charges. 4. Each undelivered article will be returned to the return address specified on the article by ordinary post at which time the Customer, or person nominated as the return addressee on the Print Post Application Number form, shall pay the cost of the return postage. The cost of the return postage will be assessed at the appropriate ordinary letter rate unless prior alternative arrangements have been made with Australia Post.* 5. A 5¢ fee applies to each CBD and residue article where correct addressing conditions specified in the Print Post service guide are not observed.* *Refer to the Print Post service guide (number 8834059) section 1.8 for further details Signature (Customer or Agent) Date Name and organisation (block capitals please) Australia Post use only Has correct addressing been observed? A 5¢ fee applies to each CBD and Residue Article if correct addressing is not observed. QTY X 5¢ Name of accepting officer Telephone number Office of lodgement Time of lodgement Yes FAP220/221/225 number ( ) ABN 28 864 970 579 / / No Date Stamp Is Air Carriage required? Yes No State Quantity Weight (kg) If “Yes”, list total number and weight (in kgs) NSW/ACT to each state. VIC If air carriage is required, an air premium is QLD Near charged in addition to the basic charge for surface carriage. WA Far Near Far • To meet delivery standards for day of lodgement, Print Post articles are to be lodged by midday. SA TAS • Advance notice of large lodgements is always advisable. NT Totals 8835283•Oct 2012

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