AEU NTPS Payroll Deduction Authority

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Authority to Deduct Dues
Unit 3 / 8 Totem Road, Coconut Grove NT 0810
PO Box 41863, Casuarina NT 0811
Phone: (08) 8948 5399 Fax: (08) 8948 2577 email [email protected] web www.aeunt.org.au
I,
Name in Full
of
Private Address
WORKPLACE
AGS number
Current classification:
Current Annual Salary:
(excluding allowances, HDA)
Hereby authorise The Department of Business and Employment (DBE) Payroll Services to deduct my
union fees from my salary each fortnight. The amount is as per the AEU-NT schedule of union fees, and
this amount may vary as determined from time to time by the AEU-NT Branch Executive, and according
to my substantive salary. This amount is to be forwarded to the
AEU-NT Branch
PO Box 41863
CASUARINA NT 0811
I further authorise DBE and the Department of Education and Training to release to the AEU-NT Branch
my AGS number, salary details, classification, increment point, TEP allowance, Highly Accomplished or
Leading Teacher status, full time/part time status, and fee deduction amount upon request by the AEUNT Branch.
I understand that I may revoke this authority at any time by writing to the Payroll Manager, DBE, PO Box
1900, Palmerston NT 0831 and that upon receipt of such communication DBE will immediately revoke
this authority. Alternatively, I understand that I may send my written revocation to the AEU-NT Branch,
who will forward it to DBE on my behalf.
Signature
Date
To be completed by AEU-NT before submission to DBE Payroll Services
Deduction Ref:
UN0110
Fortnightly
Deduction Amount: $__________
16043200
AEU endorsement
__________________
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