Direct Debit Request: Personal Loan Repayment

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Westpac Banking Corporation ABN 33 007 457 141
AFSL and Australian credit licence 233714
Direct Debit Request: Personal Loan Repayment
Our privacy policy is available at .au or by calling 132 032 and covers how we handle your personal information.
This form allows you to nominate an account from which you would like us to withdraw loan repayments. Please read the
Direct Debit Request Service Agreement (overpage) before completing steps 1 to 4 below and returning to Westpac
Step 1
Your Details and Personal Loan Account Details
Full Name
Residential Address
Postcode
Contact phone number
Personal Loan account number
(
)
Step 2
Details of the account to be debited
Name and address of financial institution at which the account is held
Account name(s)
BSB number
Account number
Step 3
Monthly Repayment Options
I/we would like Westpac to debit my/our nominated account on the monthly payment date for the minimum monthly payment specified
in the Personal Loan contract.
I/we would like Westpac to debit my/our nominated account on the monthly payment date for an amount higher than the minimum
monthly payment specified in the Personal Loan contract.
Please specify amount
$
Step 4
Your Authority
I/We authorise and request Westpac Banking Corporation (User ID 039159) to debit my/our account referred to below with my/our
nominated repayment amount through the Bulk Electronic Clearing System.
I/we accept the Direct Debit Request Service Agreement.
(all account
Name (please print)
Name (please print)
holders to sign)
Signature (1)
Signature (2)
✗
✗
Date
/
/
Date
/
/
Send to
Account Services Team
Group Operations (IBN 050)
1 King St, Concord West NSW 2138
or
Fax to (02) 9767 0770
Page 1 of 2
WAL067S1 (03/14) 376041

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