Rates direct debit request New application Change of account details only Customer AuthorityName and property details of the customer giving the direct debit request.Name* First Last Name First Last Authorise Clarence City Council (User ID 064064) to arrange for funds to be debited from my/our account at the financial institution identified below and as prescribed below through the Bulk Electronic Clearing System (BECS). This authorisation is to remain in force in accordance with the terms described in the Direct Debit Request Service Agreement (“the Agreement”) on the reverse of this form Property address* Street Address Address Line 2 City State Post code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact phone number*Email Details of the account to be debitedSavings or cheque accounts only.Name of financial institution* Branch of financial institution* Account name (e.g. J & J Smith)* BSB number* Account number* Indicate frequency of direct debit*Fortnightly - Debited every second FridayMonthly - Debited last business day of the monthInstalment Dates - Debited on the instalment due date for the instalment amountAnnually - Debited on first due date for the financial year for the full years ratesCouncil will calculate your direct debit payment amount to ensure your rates balance is paid in full by the end of the financial year.Date of commencement Day Month Year ConsentConsent* I/We authorise the following: 1. The debit user to verify the details of the above-mentioned account with my/our financial institution. 2. The financial institution to release information allowing the debit user to verify the about mentioned account details. The personal information on this form is required by council for the payment of rates. We will only use your personal information for this and related purposes. If this information is not provided, we may not be able to deal with this matter. You may access and/or amend your personal information at any time. How we use this information is explained in our Privacy Policy, available at www.ccc.tas.gov.au or at the council offices.Name* First Last Date* DD slash MM slash YYYY CAPTCHA Direct Debit Request Service AgreementIn this Agreement the following words and expressions have the following meanings unless the context requires or suggests otherwise: Business Day means a day that is not a Saturday, a Sunday, Easter Tuesday or a statutory holiday (as defined in the Statutory Holidays Act 2000 (Tas.)) generally observed in Hobart; Council includes any person administering or having authority in respect of any aspect of this Agreement on behalf of the Council; Direct Debit Request (DDR) means a payment collected from the Customer’s bank account in accordance with the DDR Form issued by Council; Financial Year means 1 July to 30 June each year; and Rates Notice means a notice issued in accordance with section 122 of the Local Government Act 1993 (Tas.) The terms of the Customer’s DDR for the payment of rates are on the DDR Form and outline the frequency of the DDR, the amount calculated to ensure the Customer’s rates balance is paid in full by the end of each Financial Year and the Date of Commencement for the DDR. Council will recalculate a DDR as soon as possible after the Rates Notice has issued to ensure rates will be paid in full by the end of each Financial Year. The Customer will be advised by Council at least thirty (30) days in advance of any changes to the DDR, including changes to the terms of this DDR Service Agreement. For all matters relating to the DDR: New DDR Forms must be received by Council seven (7) days prior to the Date of Commencement on the prescribed DDR Form. Amendments or cancellations must be received seven (7) days prior to the next Direct Debit deduction calculated based on the frequency of the Direct Debit shown on the prescribed DDR form. It is the Customer’s responsibility to ensure sufficient cleared funds are in the account to be debited as outlined on the DDR Form when the payments are to be debited. If the Customer has insufficient cleared funds or if the Customer exceeds their account transaction limit, their financial institution may charge a fee and dishonour the DDR. If the due date for the DDR falls outside a Business Day, the DDR will be processed by Council on the first available Business Day PRIOR to the Direct Debit due date. If the Customer’s DDR is dishonoured and returned unpaid, the following procedures will apply: On the first occasion – A letter will be sent to the Customer advising of the dishonoured payment, and that the dishonoured payment will be included in the next deduction due, plus the usual Direct Debit amount. On the second occasion – The DDR will be cancelled by Council by notification in writing to the Customer and the Customer will be requested to make alternative arrangements for the payment of the outstanding rates balance. The Customer should be aware that: Direct Debiting through Bulk Electronic Clearing System (BECS) is not available on all bank accounts; and Details of the Account to be debited should be checked against a recent statement from your Financial Institution. If you are in doubt, you should check with your Financial Institution before completing the DDR Form. Once the Customer’s annual rates balance shows a credit balance the DDR will cease until rates become due and payable again. In accordance with section 128(1)(c) of the Local Government Act 1993 (Tas.), Council will impose interest and penalties on any rates or instalments that are not paid on or before the date they fall due. For the 2024/25 Financial Year interest will be charged at 10.14% per annum (calculated daily) on all overdue amounts from the day after the due date and a penalty of 5% will apply to any part of an instalment amount outstanding. However, if your Direct Debit is adhered to interest and penalties will not apply. All customer records and account details will be kept private and confidential to be disclosed only at the request of the Customer or Financial Institution shown on the DDR Form in connection with a claim made to an alleged incorrect or wrongful DDR, or in accordance with council’s Privacy Policy.