HR002
PAY AUTHORISATION FORM
EMPLOYEE NUMBER:
SURNAME: (Block Capitals)
OTHER NAMES:
LOCATION
Complete one section only
SECTION1
Pay me by credit transfer to my Bank/National Giro account.
BANK NAME:
________________________________________________________
BANK ADDRESS:
________________________________________________________
________________________________________________________
________________________________________________________
BANK SORT CODE:
________________________________________________________
BANK ACCOUNT NUMBER:
________________________________________________________
ACCOUNT HOLDER
________________________________________________________
SECTION 2
Pay me by credit transfer to my building society account; I accept any delays which might occur.
BUILDING SOCIETY NAME:
________________________________________________________
BUILDING SOCIETY ADDRESS:
________________________________________________________
BUILDING SOCIETY’S BANK SORT CODE:
________________________________________________________
BUILDING SOCIETY’S BANK A/C NUMBER:
________________________________________________________
YOUR BUILDING SOCIETY ROLL NUMBER:
________________________________________________________
ACCOUNT HOLDER
________________________________________________________
Please attach any payment transfer instructions from your Society.
I hereby authorise you to remit my net pay by the method indicated above
SIGNED:
DATE: