KWS Direct Debit Request Form - Kinross Wolaroi School

Kinross Wolaroi School
Locked Bag 4 (59-67 Bathurst Road), Orange 2800 NSW
Accounts telephone (02) 6392 0314 facsimile (02) 6392 0381
www.kws.nsw.edu.au ABN 87 938 495 176
________________________________________________________________________________________
Student Details
Name of Student(s)
________________________________________________________________________________________
Parent
Authority
Name of Parent(s)
Residential address
Postcode
I/We request and authorise KINROSS WOLAROI SCHOOL (Debit User Id 425908) to arrange for
$_________.____ to be debited from my/our account at the financial institution identified below on the 20 th day of
each month as prescribed through the Bulk Electronic Clearing System or to debit my/our account by other means.
This authorisation is to remain in force in accordance with the terms described in the Service Agreement attached.
________________________________________________________________________________________
Details of the
Account to be
debited
Name and address of the financial institution at which your account is held
Postcode
Name of account holder(s)
BSB number
|__|__|__|-|__|__|__|
Account number
|__|__|__|__|__|__|__|__|__|
Acknowledgement (if account in joint names, both parents to sign this section)
By signing and/or providing us with a valid instruction in respect to your Direct Debit Request, you have
understood and agreed to the terms and conditions governing the debit arrangements between you and Kinross
Wolaroi School as set out in this Request and in your Direct Debit Request Service Agreement.
Signature: ________________________________
Date: ____ / ____ / _____
Signature: ________________________________
Date: ____ / ____ / _____

Kinross Wolaroi School
Locked Bag 4 (59-67 Bathurst Road), Orange 2800 NSW
Accounts telephone (02) 6392 0314 facsimile (02) 6392 0381
www.kws.nsw.edu.au ABN 87 938 495 176
Please ensure that you have read the following before sending the Direct Debit Request to the
School.
The School may vary this agreement at any time by giving you at least 14 days notice.
By signing a Direct Debit Request, you request and authorise us to arrange for funds to be debited from your
account.
The School will only arrange for funds to be debited from your account per the following:
(a) as requested and authorised in the Direct Debit Request;
(b) according to any notice sent to you specifying the amount payable and the date the payment is due;
(c) a change as requested by the family.
As all fees must be paid in full by the last day of Term 4, the School will write and advise the final balance needed to
clear the account in November where it differs from the regular monthly instalment. You will be asked to contact
the School on (02) 6392 0313 where this final payment presents an issue and you will not authorise the additional
amount beyond the regular monthly instalment to be processed.
The payment will be deducted from your nominated account on the 20 th day of each month from 20 February
2014 through to and including 20 November 2014. If the payment date falls on a public holiday, the payment will
be processed on the next working day.
It is your responsibility to ensure that you have sufficient funds in the nominated account when payments are to
be drawn. If you do not have sufficient funds, the transaction will be rejected and a dishonour fee will be charged
to your account. The School has to treat the payment as if it were never made.
Please be aware that:
(a) Direct Debiting through Bulk Electronic Clearing System is not available on all accounts;
(b) Account details should be checked against a recent statement from your financial institution. If you are in
any doubt, you should check with your financial institution before completing the Direct Debit Request; and
(c) It is your responsibility to advise us if your nominated account is altered, transferred or closed.
Your records and account details will be kept private and confidential and will only be disclosed at your request
or at the request of the financial institution in connection with a claim made to an alleged incorrect or wrongful
debit, or otherwise as required by law.
For all matters relating to the Direct Debit arrangement on your account, including requests for the deferment
of debits, alteration of debit arrangements, stopping or cancelling your Direct Debit Request or if you believe an
error has occurred in debiting your account, please contact the School’s Accounts Office on (02) 6392 0313.
Alternatively you can contact your own financial institution.
Please retain this page for your records.