Direct debit request to pay municipal rates and charges
Step
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Unique ID
Information
If at any stage you come across a question you cannot answer, please use the
save and continue button
at the bottom of this form to save your application so you can return later when you have the appropriate information.
This request remains in force until you notify us in writing that you no longer wish to pay your rate instalments by direct debit.
Council will charge a dishonour fee if a direct debit payment is dishonoured.
Enquiries can be directed to the Rating Department on 03 5358 8710.
Deductions can only be made from a
Nominated Bank Account - Not a credit card.
Your property details
Company Name
If applicable
Primary property owners name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Phone
(Required)
Postal Address
(Required)
Street Address
Address Line 2
Town
State
Postcode
Additional Property Owners
Enter property owners. Click the plus button to add further names.
First Name
Surname
Add
Remove
Properties
(Required)
Please list all the properties for this request.
Assessment numbers can be found on your rates notice.
Please click the plus button to add more properties.
Assessment Number
House/Street Details
Suburb
Postcode
Add
Remove
Payment Cycle
Payment Period
(Required)
Quarterly instalments (deducted on the due date)
Monthly instalments (deducted on or next working day after 20th day of the month)
Fortnightly instalments
If paying via the fortnightly or monthly direct debit option Council will contact you to discuss the start deduction date and amounts. Once set up, Council will notify you in writing of the set amount/s and dates on which the direct debit will be processed. Applications can be completed at any time during the year. Note:- Deductions can only be made from a
Nominated Bank Account - Not a credit card.
Bank account details
Bank/Financial institution
(Required)
Branch
(Required)
BSB
(Required)
Account number
(Required)
Acknowledgement
Direct Debit acknowledgement
I/We authorise and request the Northern Grampians Shire Council ( APCA User ID Number 305226 ) to arrange for funds to be debited through the Bulk Electronic Clearing System (BECS) from my/our account at the financial institution identified above as instructed by me/us for the payment of municipal rates and charges. I/We acknowledge that this Direct Debit arrangement is governed by the terms and conditions of the
Direct Debit Request Service Agreement (DDRSA)
as provided to me.
Direct Debit: I acknowledge that:
(Required)
I have read, understood and agree to the Direct Debit acknowledgement above
Privacy Collection Statement
Personal information requested on this form will only be used by council to carry out its functions and activities and will not be disclosed without your consent except where authorised by law. If you do not provide all or part of the personal information required we may not be able to process your request in an effective and efficient manner. You have the right to seek access to and correction of your personal information.
Privacy Collection Statement: I acknowledge that:
(Required)
I have read, understood and agree to the Direct Debit acknowledgement above
Submission Statement
This request can only be made by the named applicant. If you are submitting this application on behalf of another person or entity you must be duly authorised to do so. By submitting this application you are confirming that you are authorised to do so and declare that the information is correct to the best of your knowledge.
Submission Statement: I acknowledge that:
(Required)
I have read, understood and confirm I am complying to the above Submission Statement
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