BPAY-Request-form

PURPOSE OF THIS FORM

For authorised officers of the below named client to request the BPay payment as detailed in this form.

INSTRUCTIONS FOR COMPLETION

All fields are mandatory and must be completed by two account signatories on the debit account before returning the form to the CDF.
Please provide your electronic signature where indicated below.

SECTION 1 – CDF ACCOUNT TO BE DEBITED

Account Name*

Member No.*

Account No. (S A/c)*

Amount ($)*

Reference (to appear on CDF Statement)*

SECTION 2 – BPAY BILLER TO BE CREDITED

BPAY Biller Name*

BPAY Biller Code*

Customer Reference No.*

Validation Confirmation*

I confirm the BPay details as listed above have been validated either verbally with the vendor, against prior payment details or by using a validation system.

SECTION 3 – AUTHORISATION

I/We the below authorised signatories on the above listed CDF account, approve the CDF to complete the requested transaction and debit the specified CDF account for the value of the transaction and any associated fees.

Name of Authorised Person 1*

Name of Authorised Person 2*

Signature of Authorised Person 1*

Please sign above using your mouse, touchscreen, or stylus.

Signature of Authorised Person 2*

Please sign above using your mouse, touchscreen, or stylus.

Date (Authorised Person 1)*

Date (Authorised Person 2)*

FOR SAME DAY PROCESSING REQUESTS MUST BE RECEIVED AT THE CDF BY 2:20PM (AEST)

Disclosure Statement | Privacy Collection Statement

BPAY REQUEST 2025/01

CDF BPAY Request

PURPOSE OF THIS FORM

INSTRUCTIONS FOR COMPLETION

SECTION 1 – CDF ACCOUNT TO BE DEBITED

SECTION 2 – BPAY BILLER TO BE CREDITED

SECTION 3 – AUTHORISATION