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 accounts@aeunt.org.au 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 __________________