Direct Debit Request Bank



|Direct Debit Request |[pic] |

By signing this document, I authorise St.George Bank - A Division of Westpac Banking Corporation (ABN 33 007 457 141 AFSL 233714 Australian credit licence 233714 (‘St.George”) to act on its own behalf or as agent of St.George Finance Limited (ABN 99 001 094 471 Australian credit licence 387944) or St.George Motor Finance Limited (ABN 53 007 656 555 Australian credit licence 387946) (whichever is the financier in the finance contract).Debit User Number 306625 (Debit User) to debit my account, detailed in the Schedule below, through the Bulk Electronic Clearing System, with any amount I must pay you when due under the arrangement I have entered into with you on or about the date of this Direct Debit Request.

This direct debit is to remain in force until further notice.

|Account Number ( |      |

|Please Supply your contact Information ( MUST BE COMPLETED ) |

|Full Name: |      |

|Address: |      |

|Contact Number (H): |      | Contact Number (M): |      |

|The Schedule |

|Financial Institution Name: |      |

|Address: |      |

| |      |

|Account Title: (e.g. John Smith) |      |

|BSB Number: (Must be 6 digits) |  |  |  |  |  |  |

|Account Number: |  |  |  |  |  |  |  |  |  |

|Customer Acknowledgement |

I acknowledge that:

|( | this Direct Debit Request is governed by the terms of the Bulk Electronic Clearing System and the Direct Debit Service Agreement provided by St.George. |

|( |direct debits will appear on my bank account statement for my account debited as “St.George-Comm Fin”. |

|Customer Declaration |

By signing this Direct Debit Request I declare that:

|( |this Direct Debit Request authorises you to instruct my financial institution to debit my account (as described above) on my behalf |

|( |all information given to you is accurate and not misleading and I am aware that you are relying on it |

|BEFORE SIGNING THIS DOCUMENT |

| | |

|( |fill in or cross out any blank spaces |

|( |ensure that if more than one signatory is required to operate the account described above, each required authorised signatory signs this Direct Debit Request |

| |or a copy of this form and return all the original signed forms to us |

|( |do not sign this form if there is anything that you do not understand |

|( |our privacy policy is available at .au or by calling 13 33 30 and covers how we handle your personal information |

|……………………………………………………….. |……………………………………………………….. |

|Signed Signatory 1 |Signed Signatory 2 |

|      |      |

|……………………………………………………….. |……………………………………………………….. |

|Print Name |Print Name |

|Dated: / / |Dated: / / |

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