GEW0177 Generic DD Form Web

1 Direct debitrequestThe quick and convenient way to pay Your payments will be automatically taken from your cheque or savingsaccount on the due date. Direct Debit can only be set up to take out payments complete andreturnthis form :Direct Debit AdministrationPO BOX 940, Melbourne, VIC 30011300 369 905 Account NumberFull NamePlease make sureyou read the direct debit service agreement on the following detailsPayment optionDetails of account to be debitedYour authorisationMy preferred method of payment each month is (Please tick one box only):Minimum monthly payment, plus any overdue and over limit amountFixed amount of(Minimum amount of $10)OR Minimum monthly payment, plus any overdue and over limit amount (whichever is greater)Full closing balance payment as shown on my account statement(Wecan only accept bank account details that areinthe sole name of the account holder or fromajoint bank account includes the name of the account holder.)

2 I/Weacknowledge that this direct debit arrangement is governed by the terms of the direct debitrequest service agreement overleaf. If thenominated bank account isajoint account, both account holders signatures Latitude Finance Australia (ABN 42 008 583 588) to debit the account described above with the amount of the paymentdue on my account as specified in the payment option schedule of FinancialInstitutionBranch NameName of account tobe debited(eg Name in whichthe account isHeld ie. John Smith)NameSignatureDateBSB numberAccountholderJoint account holder(If nominated bank account isajoint account)Account numberGEGE000010_Web 01/16 TitleFirst Name(s)

3 Last NameDirect Debit Request Service AgreementThe meaning of words printed like this in this Direct Debit RequestService Agreement is explained Debiting your By signingadirect debitrequest, you have authorised us toarrange for funds to be debited from your We will arrange for your financial institution to debit youraccount in accordance with your instructions given to us in thePayment Option Schedule. If, however,adebit payment is due onaday:(a) which is not contained inaparticular month; or(b) which is notabusiness day,then the debit payment will be made on the last day of that monthor on the preceding business ou areuncertainas to whenadebit payment will be processed, you should contactyour financial institution for Changes by usWe may vary any details of this agreement or the direct debitrequest at any time (including cancelling it).

4 We will give you noticein writing of any such change at least fourteen (14) days beforethechange takes Changes by youYoumay request to stop or deferadebit payment or alter,suspend or cancel the direct debitrequest at any time. Whenwe receive sucharequest, we will inform you of our notificationrequirements for Your It is yourresponsibility to ensurethat thereare sufficient clearfunds available in your account to allowadebit payment to bemade in accordance with the direct If thereare insufficient clear funds in your account to meet adebit payment:a) you may be chargedafee and/or interest by yourfinancial institution.

5 (b) you may also incur fees or charges imposed or incurredby us, and(c) you must arrange for the debit payment to be made byanother method or arrange for sufficient clear funds to be inyour account by an agreed time so that we can process thedebit Youshould check your account statement to verify that theamounts debited from your account If we areliable to pay goods and services tax ( GST ) on asupply made by us in connection with this agreement, then youagree to pay us on demand an amount equal to the considerationpayable or the supply multiplied by the prevailing GST If you believe that therehas been an error in debiting youraccount, you should notify us We will investigate and deal promptly and in good faith with anysuch query,claim or complaint.

6 If your query,claim or complaintcannot beresolved to your satisfaction in that call, we will informyou at that time of the length of time which we estimate theinvestigation will If we conclude asaresult of our investigations that youraccount has been incorrectly debited we will adjust your account(including interest and charges) accordingly by directly creditingyour account or sending youarefund cheque at our will also notify you of the adjustment either orally or in If we conclude asaresult of our investigations that youraccount has not been incorrectly debited we willrespond toyour query by providing you withreasons and any evidencefor this Any queries you may have about an error made in debitingyour account should be directed to us in the first instance so thatwe can attempt toresolve the matter between us and you.

7 If wecannotresolve the matter you can stillrefer it to your financialinstitution which will obtain details from you of the disputedtransaction and may lodgeaclaim on your Youshould check:(a) with your financial institution whether direct debiting isavailable from your account as direct debiting is notavailable on all accounts offered by financial institutions;(b) that your account details which you have provided to usarecorrect by checking them againstarecent accountstatement;and(c) with your financial institution if you areuncertain abouteither of the above matters beforecompleting the We will keep any information (including your account details) inyour direct debitrequest will makereasonableefforts to keep any such information that we have about you secureand to ensurethat any of our employees or agents who haveaccess to information about you do not make any unauthoriseduse, modification,reproduction or disclosureofthat We will only disclose information that we have about you.

8 (a) to the extent specificallyrequired or authorised by law; or(b) for the purposes of this agreement (including disclosinginformation in connection with any query or claim); or(c) with your implied or express DefinitionsAccountmeans the account held at yourfinancial institution from which weareauthorised to arrange for funds tobe this Direct Debit RequestService Agreement between youand daymeansaday other thanaSaturdayor aSunday orapublic holiday listedthroughout paymentmeansaparticular transaction whereadebit is debit requestmeans the Direct Debit Requestbetween us and ,weor ourmeans Latitude Finance AustraliaABN 42 008 583 umeans the person(s)

9 Who signed thedirect ur financial institutionmeans the financial institution whereyou hold the account that you haveauthorised us to keep this information for your ownrecordsCredit provided by Latitude Finance Australia (ABN 42 008 583 588).Australian Credit Licence Number 392145