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PAYROLL DEDUCTION AUTHORITY Employee name: Cost Centre BANK DEDUCTIONS: Please CIRCLE the CANCEL Deduction option to indicate the deduction variation BANK NAME BRANCH NO. A/C NUMBER must be 6 digits max. 9 digits CHANGE Existing Deduction NEW Deduction A/C NAME AMOUNT $ $ NETT I hereby authorise these amounts to be deducted from the next pay period or from pay period / / , and to continue during my employment with Council. This authority will remain in force until it is either revoked or amended by me in writing. SIGNATURE: PAYROLL SERVICES USE ONLY: Payroll-1-1-F1 DATE: SIGNATURE: DATE Revision: 1 Page - 1 of 1