Update form test

Title

Such as Mr, Mrs. Miss, Ms, Dr

First Name*

Surname*

Preferred Email address*

Preferred Contact number

Which of your details have changed since your last update or into the future? (Please select one or more)*

-- Contact details i.e address
-- Employment details i.e workplace, point time or step
-- Taking a period of unpaid leave greater than 1 month i.e Maternity leave
-- Payment details
-- No details have changed

Contact Information

Address

Street Address Suburb Post code

Alternate Email address

Employment Details

Current place of Employment*

Campus/Suburb

Point time

Employment Type*

-- Teacher
-- Non-Teaching

-- This is my first year teaching

Step / PT / GT

Teacher Level

School Level

Additional Responsiblity

Such as POR, AST, HAT, LEAD, APRIM)

Stream

Grade

Year Level

Weeks per Year Worked

Average Hours per Week Worked

Other information

Leave Commencement Date*

Leave Completion Date*

Fee Category*

Payment information

Payment method*

Upon completion, please contact the IEUSA on 8410 0122 with your credit card details or fill out the credit card debit form attached to your update confirmation email and return it to the IEUSA so that your membership can be processed.

Financial Institution*

Account name*

BSB*

Account number*

DIRECT DEBIT REQUEST SERVICE AGREEMENT Independent Education Union (South Australia) Branch 213–215 Currie Street, Adelaide SA 5000 You have entered or are about to enter into an arrangement under which you make payments to us. You want to make those payments by use of the Direct Debit System. This agreement sets out the terms on which we accept and act under a Direct Debit Request (“your Direct Debit Request”) you give us to debit amounts from your account under the Direct Debit System. It is additional to the arrangement under which you make payments to us. Please ensure you keep a copy of this agreement as it sets out certain rights you have against us and certain obligations you have to us due to giving us your Direct Debit request. OUR AGREEMENT: 1. We agree to be bound by this agreement when we receive your Direct Debit Request complete with the particulars we need to draw an amount under it. 2. We agree only to draw money out of your account in accordance with the terms of your Direct Debit Request. WHAT WE CAN DO: 3. On giving you at least 14 days notice, we may: (a) change our procedures in this agreement; (b) change the terms of our Direct Debit Request; or (c) cancel your Direct Debit Request. YOU MAY ASK US TO: 4. (a) alter the terms of your Direct Debit Request; (b) defer a payment to be made under your Direct Debit Request; or (c) stop a drawing under your Direct Debit Request. Or you may cancel your Direct Debit Request by forwarding a request in writing clearly stating your membership number, name, address, contact telephone number and the action you wish IEU(SA) to take on your behalf. 5. You may dispute any amount we draw under your Direct Debit Request by contacting the IEU(SA) office and discussing your concern with the Membership Officer. Should your dispute not be resolved in this manner, you are requested to forward a signed statement to the Secretary by post, email or fax (Fax: 8410 0282) outlining your dispute along with what action has already been taken. HOW WE WILL HANDLE A DISPUTE: 6. We deal with any dispute under clause 5 of this agreement as follows: (a) check that we have your IEU(SA) subscription details recorded correctly; (b) correct any inaccuracy and notify you accordingly by telephone, email or post; (c) if our records are correct, contact you by telephone or in writing within 14 days outlining the prescribed fees; (d) if you are not satisfied with the action taken, we will advise you of further action available under the IEU(SA) Constitution. GENERAL INFORMATION: 7. We draw on your account under your Direct Debit Request on or after the first Wednesday of the month. 8. If your financial institution rejects any of our attempt/s to draw an amount in accordance with your Direct Debit Request, we will make contact with you by telephone or in writing to ascertain: (a) if the bank details provided to us are correct; (b) if you wish to change your method of payment or (c) if there is any other reason why your financial institution has rejected our attempt to draw the required amount. 9. We will not disclose to any person any information you give us on your Direct Debit Request, which is not generally available, unless (a) you dispute any amount we draw under your Direct Debit Request and we need to disclose any information relating to your Direct Debit Request or to any amount we draw under it to the financial institution at which your account is held or the financial institution which sponsors our use of the Direct Debit System or both of them; (b) you consent to that disclosure, or (c) we are required to disclose that information by law. 10. Not all accounts held with a financial institution are available to be drawn on under the Direct Debit System. 11. Before you complete your Direct Debit Request, it is best to check account details against a recent statement from your financial institution to ensure the details on your Direct Debit Request are completed correctly. YOUR RESPONSIBILITY: 12. It is your responsibility to ensure there are sufficient clear funds available in your account by the due date on which we draw any amount under your Direct Debit Request, to enable us to obtain payment in accordance with your Direct Debit Request. 13. We request you to direct all requests to stop or cancel your Direct Debit Request and all enquiries relating to any dispute under Clause 4 of this agreement to us initially. Last updated: 27/01/17

Please agree*

I/We authorise The Independent Education Union of South Australia (IEUSA) Branch, ABN 26 954 644 024, the Debit User, (No. 077399), to debit my/our account, detailed in the Schedule below, through the Direct Debit System, with any amount I/We must pay you when due under the arrangement between us. This authority is to remain in force until further notice.

Resignation of your membership must be in writing and will take effect 30 days from receipt of your request, with fees payable until the date of effect.

Our terms and conditions can be found at www.ieusa.org.au/terms-and-conditions/

Update form test

Membership update

Contact Information

Employment Details

Other information

Payment information