AUTHORITY TO DEDUCT SUBSCRIPTIONS TO THE
RETIRED POLICE ASSOCIATION of NSW Inc.
FROM POLICE SUPERANNUATION:
Surname: - ______________________________________________
Given Names: - ______________________________________________
Address: - ______________________________________________
_____________________________ Postcode _________
I hereby authorise the State Authorities Superannuation Board to deduct from my pension,
Seventy cents (.70c) per fortnight representing my subscriptions to the Retired Police Association of NSW Inc.
for membership, and to forward all deductions to the Retired Police Association, effective from this date.
I acknowledge that this rate may be varied without reference to me in the event that notice of change is received
by State Super from the Retired Police Association of NSW Inc.
NOTE: Deductions will not be made unless this authority is completed and signed. Any directions or authority now
given shall continue in force until such time as varied or revoked by me on written notice to the Board.
__________________________________________ _________________ _______________
Applicant’s Signature. Phone No. Date.