AUTHORITY TO DEDUCT SUBSCRIPTIONS TO

THE RETIRED POLICE ASSOCIATION OF NSW Inc.

FROM MY POLICE CREDIT UNION ACCOUNT:

Name:   _________________________________________ C/U Acct No: ___________

Address:  _______________________________________________________________

Phone:  ___________________________________ Mobile: ______________________

AUTHORITY DETAILS.

From Account:     ___________________________________ Acct No. + S1, S2, S10 etc

Commencing:                  Immediately the sum of $18.20 and then                               .

Please pay:                      On 1^st July of Each Year Thereafter, Until Further Notice      .

Amount:                                          Eighteen Dollars & Twenty cents ($ 18.20 ) per year         .

Payable To:                     Retired Police Association of NSW Inc.                                  .       

Address of Payee:          PO Box 50, REGENTS PARK  NSW  2143                                  .

AUTHORITY STATEMENT:

I hereby authorise the Police Department Employees’ Credit Union Limited to make the recurring payment detailed above until this authority

is revoked by me and to froward such deduction to the Retired Police Association of NSW Inc.

I acknowledge that this rate may be varied without reference to me in the event that notice of change is received by the Credit Union

from the Retired Police Association of NSW Inc.

I understand that although the Credit Union will endeavour to effect such periodical payments it accepts no responsibility to make the

same and accordingly the Credit Union shall not incur any liability through any refusal or omission to make all or any of the payments or by

 reason of late payment or by any omission to follow any such instructions.

Signature:  _____________________________________ Date:  ___________________

_____________________________________________________________________________________________________

OFFICE USE ONLY.

                BRANCH STAFF.                                                ADMIN SERVICES.

Authority No: __________ (If existing PP)      Authority No:_____________(If new PP)

Checked by:  ________________________       Processed by: ____________________

Operator No: __________ Date: _________           Date:  ________________________

____________________________________________________________________________________________________________________