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 Home Join the PSA
[C] Authority for Deduction from Pay of Subscription to the PSATo be returned to Membership Section, PSA/CPSU, GPO Box 3365, Sydney 2001 for processing. (Please use BLOCK letters or type all details) Employees Payroll Serial Number To the Accountant at (Department/Authority) I, Title (Mr/Mrs/Ms/Dr etc) Name in full hereby authorise you to deduct my annual ubscription to the Public Service Association of New South Wales from my salary. The amount is to be deducted in regular fortnightly instalments and based on the scale of subscriptions which the Public Service Association of New South Wales from time to time certifies to you as the scale of subscriptions payable to it by its members. I also authorise you to forward the amount of the subscription to the Public Service Association of New South Wales, 160 Clarence Street, Sydney. All payments made on my behalf pursuant to this request shall be deemed to be payments to me personally. I desire this authority to remain in force until cancelled by me. In consideration to your consenting to make such deduction and payment as above, I agree for myself, my executors, administrators and assignees to hold Her Majesty, the Department/Authority: (fill in name of dept/agency/etc) and every employee thereof harmless and indemnified against any claim arising out of any act or omission to act in pursuance of this Authority or any failure to make deductions and remittances as authorised herein. Signature
Date ______/______/_________
Date ____/____/____ When you have read the obligations print out this form, complete it, then sign it. The completed form must be posted to us as we need your signature.
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