Centrepay Form Centrepay Form Centrepay Form Please enable JavaScript in your browser to complete this form.Part A – Your Details Name *FirstMiddleLastDate Of Birth *Phone Number *Pets Name *FirstLastYour last name is your pets last name If you have more than one pet place their names here Part B – Type of requestWhat are you wanting to do? *Start a new deduction - Please complete Parts C, D & FChange a current deduction - Please complete Parts C, E & FPart C – Business Details Safe Pets Safe Families Inc. Business Address PO Box 427, CHRISTIES BEACH SA, 5165. Business Centrelink Reference Number 555-125-116-L Reason for deduction *Contribution for an animal in foster careVet care for your animal other reason Centrelink Reference Number *Part D - To START a new deduction From which payment do you want the deduction to be taken? *NewstartFamily Tax Benefit Aged PensionDisability PensionYouth AllowanceOtherIs this a one off payment or a fortnightly deduction? *Fortnightly DeductionOne off payment What is the fortnightly payment amount?This is the amount your caseworker would of informed you ofWhat is the one off payment amount?Which payment date do you want the deduction(s) to start from? *Your next available payment dateA future payment date Please choose a future start date for payments Part E – To change your current deduction or target amountIf you are setting up a new deduction, go straight to Part FChange current fortnightly deduction amount toChange target amount to Part F – Authorisation – Read, sign and date the statementI give permission for: The information I have provided on this form to be given to the Business The Business that I have nominated on this form to provide my correct account of billing number to the Department of Human Services if required I understand that: It is my choice to have this amount deducted from my Centrelink payment(s) and I can change my Centrepay deduction(s) at any time. If I cancel my Centrepay deductions, I am removing my consent for the Business to take further deduction(s) from my payments. If I stop using the Business but do not stop my Centrepay deduction(s), the Business may instruct the Department of Human Services to stop the deduction(s) If I have a current Centrepay deduction and I lodge a new claim, then the existing deduction(s) will not carry over to the new claim If I have current Centrepay deduction(s) and I transfer to another Centrelink payment that allows Centrepay, I should confirm that my deduction(s) have been transferred SignatureClear SignatureDate / TimeEmailSubmit Connect With Us On Insta Share this:TwitterFacebookLike this:Like Loading...