CASHING IN LONG SERVICE LEAVE APPLICATION
HRIS 022
To meet auditing requirements please clearly fill out all sections of this form
EMPLOYEE ID:
FAMILY NAME:
GIVEN NAMES:
DIVISION/PORTFOLIO:
SCHOOL/UNIT:
I would like to request that the following amount, in full-time equivalent (FTE) days, of my Long Service Leave (LSL)
entitlement be paid to me in cash:
Number of days to be paid: _____________ LSL calendar days.
I request that the sum due to me from the University of South Australia for cashing in my LSL entitlement be paid into:
Please tick (√)
□ My main bank account as recorded on the HR Information System currently
OR
□ An alternative bank account as detailed below:
Alternative Bank Account Details – LSL payment only
Selecting this option will effect the payment of LSL entitlement only. Should you wish to permanently change your bank details please
use myHR. Access via myUniSA - my Details,(https://my.unisa.edu.au/staff/Portal/myDetails/Personal/Leave.asp) For further
information on myHR please click here
Financial Institution:
Branch:
Account Name(s):
BSB number:
___-___
Account Number: __________________________________
Please confirm BSB/Account details with your financial institution to avoid delays.
Please note: Independent financial and taxation advice is recommended prior to making request for payment.
I confirm that I have a Long Service Leave entitlement of ninety-one (91) days (pro-rata for fractional staff) and would like
to make a request to have the amount I have nominated above paid to me in cash. I understand that my Long Service
Leave entitlement balance will reduce by the amount of days I have requested be paid to me in cash and that I have no
further claim to that entitlement.
Employee’s Signature: ____________________________________________________________________
Date: ____________________________________
For office use only:
Criteria for payment confirmed □
Payment made to bank account as specified above □
LSL entitlement reduced □
Last revised 5 March 2009