AUTHORITY TO DEDUCT SUBSCRIPTIONS TO THE

RETIRED POLICE ASSOCIATION of NSW Inc.

FROM POLICE SUPERANNUATION:

Surname: -         ______________________________________________

Given Names: -  ______________________________________________

Address: -          ______________________________________________

                           _____________________________ Postcode _________

AUTHORITY STATEMENT:

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.