Salary Packaging
Amendment Form
Place your cursor over each field to see tips for filling in that field. Red fields
are mandatory. This onscreen tip and buttons won't be visible on printed
version. This same form can be printed and filled in manually by hand.
1. Your Current Details: (Please confirm who you are and where you work)
Organisation Name:
Payroll No:
Full Name:
Salary Options
Unique ID:
Contact No:
Date of Birth:
Email Address:
2. Changes You Wish To Make: (Please tick all that apply)
Change of Packaging
Amount or Expense
Change of
Bank Details
Change of
Contact Details
Instructions
(Please describe the change you would like to make below)
If you would like a Living Expenses Card or Meal Entertainment Card, please complete an online card application by
logging into your online portal. Please contact our office on 1300 660 416 for further assistance.
3. New Bank Account Details
Please complete new banks account details below. If there are no changes, please leave this section blank:
Expense Item
Bank
BSB
(or Biller Code
for Credit Card)
Transaction
Reference
Number
Account Number or
Credit Card Number
I wish for these changes to be effective from:
4. Declaration
I confirm that the information given on this form is true and correct. I understand that Salary Options will make changes
to my salary packaging arrangement based on the instructions supplied and that I am liable for any loss or damages, or
fringe benefits tax that may be incurred due to incorrect information provided in this form.
Signature:
Date:
/
/
Salary Options Pty Ltd | P.O. Box 916 Moonee Ponds, VIC 3039 | Phone 1300 660 416 | Fax 1300 731 171 | [email protected]
Salary Packaging Amendment Form | Page 1 of 1 (Updated April 2017)