Direct Debit Request (DDR) Authorisation Form

Centre

Centre*

Authoriser

Identity*

Primary Parent

Secondary Parent

Other

Child or Children's Details

Child's Full Name, Date of Birth, and Customer Reference Number (CRN)

Enter each child's details below. In the Name field, type the full name in this order: First Name, Second Name, Last Name. In the Date of Birth field, use the format: dd/mm/yyyy. Use the + button to add another child, or the – button to remove a child.

Name

Date of Birth

CRN

Family Account Number / Australian Company Number (ACN)

The 9-digit family account number shown in the top-right corner of your statement (e.g. 000-123-456)

Child or Children's Details

Child's Full Name and Date of Birth

Child's Customer Reference Number (CRN)

Family Account Number / Australian Company Number (ACN)

The 9-digit family account number shown in the top-right corner of your statement (e.g. 000-123-456)

Child or Children's Details

Organisation / Agency

Title / Role

Relationship to Child*

Child's Full Name and Date of Birth

Child's Customer Reference Number (CRN)

Family Account Number / Australian Company Number (ACN)

The 9-digit family account number shown in the top-right corner of your statement (e.g. 000-123-456)

Parent / Guardian

If you're completing this form on behalf of the child’s parent or guardian — for example, as a case manager, grandparent, foster carer, or support worker — please enter the parent or guardian’s name below. If you are the parent or guardian, you can leave these fields blank.

Parent / Guardian First Name

Parent / Guardian Second Name

Parent / Guardian Last Name

YOUTH LEADERSHIP VICTORIA
admin@ylv.com.au
ABN 62 101 456 011

ABN 32 095 551 581
APCA ID 184534 | AFSL 338256

Direct Debit Request - Authorisation Form

Customer Details

First Name*

Surname*

Telephone (Landline)

Telephone (Mobile)

Email*

Date of Birth*

DD slash MM slash YYYY

Address*

Street Address Suburb / City State /Province Postcode / ZIP Country

Account Request Type

Select from the following*

New Account

Change Debit Limit

Change Account Details

Select from the following

Payment Details

Payment Limit Amount*

This is the maximum amount to deduct at each centre where a balance occurs. $0.00 or Blank = No Limit

Surcharge Information:

Visa / MasterCard: 2.35%
AMEX: 4.4%
Bank Account: $0.88

Payment Frequency*

Weekly

This field is hidden when viewing the form

When would you like your payments to happen?

Weekly (e.g. every Monday)

Monthly (e.g. on the 1st of each month)

Day of the Week

Day of the Month

First Payment Date*

DD slash MM slash YYYY

First payment will include an establishment fee of $2.20

Payment Method

In accordance with our Payment of Fees Policy, all accounts are required to be set up on direct debit.
Our preferred method of payment is credit card.
For full details, please refer to our Payment of Fees Policy

Payment Method*

Payment Method

Credit Card

Direct Debit (from Bank Account)

Direct Debit from Bank Account, Building Society, or Credit Union

Details of the Account to be debited (All Details must be supplied):

Account Name*

BSB Number*

Account Number*

I/We authorise Debitsuccess Pty Ltd, ABN 095 551 581, APCA User ID Number 184534 to debit my/our account at the Financial Institution identified here through the Bulk Electronic Clearing System (BECS).

Credit Card

Please charge my payments to my:

Visa

MasterCard

AMEX

Name on Card*

Card Number*

Expiry Date*

Card Security Code (CSC)*

The Card Security Code (CSC) is a verification number used during transactions. It appears as Card Verification Value (CVV) on Visa® and Card Verification Code (CVC) on Mastercard®, both shown as a 3-digit number on the back of the card, and as Card Identification Number (CID) on American Express®, shown as a 4-digit number on the front.

Terms and Conditions

DEBITSUCCESS DIRECT DEBIT REQUEST (DDR) SERVICE AGREEMENT
This Agreement is designed to explain what your obligations are when undertaking a Direct Debit arrangement involving Debitsuccess. It also details what our obligations are to you and forms part of the terms and conditions of your Direct Debit Request (DDR) and should be read in conjunction with your DDR Authorisation Form.

INITIAL TERMS
I/We authorise Debitsuccess Pty Limited (ACN: 095 551 581) APCA User ID 184532 to make periodic debits on behalf of the “Business” as indicated on DDR Authorisation Form (herein referred to as the Business). I/We acknowledge that if specified by the Business, in addition to the agreed periodic debits set out in the DDR Authorisation Form, administration/setup, variation, reversal, dishonour, or processing fees may also apply and be debited under the DDR as instructed by the Business.

RELATIONSHIP
I/We acknowledge that Debitsuccess is acting as an agent of the Business and that Debitsuccess does not provide any goods or services, and has no express or implied liability in relation to the goods and services provided by the Business or the terms and conditions of any agreement with the Business.

CLEARED FUNDS
I/We acknowledge that is my/our responsibility to ensure that there are sufficient cleared funds in the nominated account by, and at all times on, the due date of the payment (“Day to Debit”) to enable the direct debit to be honoured on the Day to Debit. I/We acknowledge and agree that sufficient funds will remain in the nominated account until the direct debit amount has been debited from the account and that if there are insufficient funds available when the debit is attempted, I/we agree that I/we will be responsible for any fees and charges that may be charged by my/our Financial Institution.

VARIATIONS TO DEBIT TERMS
I/We authorise the Business to vary the amount of the payments from time to time if provided for within my/our agreement with the Business. I/We authorise Debitsuccess to vary the amount of the payments upon instructions from the Business, and where such instructions from the Business are received by Debitsuccess, I/we do not require Debitsuccess to notify me/us of such variations to the debit amount. I/We acknowledge that Debitsuccess/Business is to provide 14 days’ notice if proposing to vary the terms of the debit arrangements otherwise than as provided for herein. I/We acknowledge that my/our requests to vary, defer or stop the debit arrangement must be directed to the Business.

CANCELLING THESE DEBIT TERMS
I/We understand that I/we are able to cancel this DDR by requesting this of the Business or my/our Financial Institution, and I/we acknowledge that cancellation of the authority to debit my/our account will not terminate my/our agreement with the Business or remove my/our liability to make the payments I/we have agreed to.

NON WORKING DAY
When the day to debit falls on a weekend or public holiday the debit will be initiated on the next working day.

DISHONOURED PAYMENTS
I/We acknowledge that:
(a) if a debit is returned by my/our Financial Institution as unpaid, I/we will be responsible for any Debitsuccess fees and charges (currently up to $14.95 for each unsuccessful debit), in addition to any Financial Institution charges and collection fees (including, but not limited to, any fees of solicitors and collection agents appointed by Debitsuccess); and
(b) Debitsuccess may attempt to re-process any unsuccessful payments as advised by the Business and/or add such unsuccessful payment to any future payments.

ACCURACY OF INFORMATION
I/We acknowledge that it is my/our responsibility to ensure that the details entered on the DDR Authorisation Form are correct and that Debitsuccess is not liable to the extent that any such details are wrong and this causes a required payment to be missed. In addition, where I/we are paying the required payments by credit card and have entered the details of the credit card on the DDR Authorisation Form, I/we agree that Debitsuccess may continue to debit from the credit card in accordance with the terms of this Agreement to the extent that the credit card has expired, and that it wholly my/our responsibility to provide details of any replacement credit card to Debitsuccess via the Business.

DISPUTES
I/We acknowledge that any disputes regarding debit payments will be directed to the Business. If no resolution is forthcoming, I/we understand that I/we are to direct any such dispute to my/our Financial Institution.

OTHER AUTHORISATIONS
I/We authorise:
(a) The Debitsuccess to verify details of my/our account with my/our Financial Institution; and
(b) The Financial Institution to release information allowing Debitsuccess to verify my/our account details.

INFORMATION SECURITY
Debitsuccess agrees that it will make reasonable efforts to keep your information contained in the DDR (including account details) and any other information that we have about you confidential and secure, and will ensure that any of our employees or agents who have access to information about you do not make any unauthorised use, modification, reproduction or disclosure of that information.
Debitsuccess will only disclose information that we have about you:
(a) to the extent specifically required by law; or
(b) for the purposes of this Agreement (including disclosing information in connection with any query or claim).

Should you have any queries in relation to these terms and conditions contact
Debitsuccess Pty Ltd.
PO BOX 5567, Stafford Heights QLD 4053
Phone: 1800 956 959
E-mail: qkclients@debitsuccess.com

YOUTH LEADERSHIP VICTORIA
PO Box 1144
Dandenong VIC 3174
admin@ylv.com.au

ABN 32 095 551 581
APCA ID 184534 | AFSL 338256

Agreement and Acknowledgement*

I confirm that I have read and understood the Terms and Conditions of the Debitsuccess Direct Debit Request (DDR) Service Agreement, and I agree to the payment terms, fees, and responsibilities as set out in this form. I understand this authorisation remains in effect unless cancelled with Youth Leadership Victoria Inc or my financial institution.

Signature

This Authorisation is to remain in force in accordance with the Terms and Conditions on this Direct Debit Request, the provided DDR Service Agreement, and I/we have read and understood the same.

Authorising Signature (s)*

Date

DD slash MM slash YYYY

Payment Method

Select your preferred method of payment*

Direct Debit (from Bank Account)

Credit Card

ABN: 17 349 353 404 PH: 1800 827 234
Direct Debit Request – New Customer

Business:

ABN/ACN:

First Name:

Surname:

Mobile Phone:

Customer Reference:

Email:

Address

Street Address Suburb / City State / Province Postcode / ZIP Country

Debit Arrangement / Payment Details

I authorise and request NumeroPro Pty Ltd ATF The Kidsoft Unit Trust (Direct Debit User ID: 424700) to debit payments from my nominated account, as specified below, at intervals and amounts as directed by Youth Leadership Victoria in accordance with the Terms and Conditions of this agreement.

Child's Name

Fixed Amount

Variability

Fixed

Variable

Fee Start Date

DD slash MM slash YYYY

Frequency

Weekly

Debit from Credit Card

Card

VISA

MasterCard

Card Number:

Expiry Date:

Card Holder's Name:

By Signing this form, I/we authorise NumeroPro Pty Ltd ATF The Kidsoft Unit Trust, acting on behalf of the Business, to debit payments from my specified credit card above, and I/we acknowledge that NumeroPro Pty Ltd ATF The Kidsoft Unit Trust will appear as the business name on my credit card statement. Furthermore, I/we agree to reimburse NumeroPro Pty Ltd ATF The Kidsoft Unit Trust for any successful claims made by the Card Holder through their financial institution against NumeroPro Pty Ltd ATF The Kidsoft Unit Trust Transaction

Fee: $0.10 + 1.55% Visa/Mastercard
Failed Transaction Fee: $0.00

Direct Debit Service Agreement

The following is your Direct Debit Service Agreement with NumeroPro Pty Ltd ATF The Kidsoft Unit Trust ABN 17 349 353 404. The agreement is designed to explain what your obligations are when undertaking a Direct Debit arrangement with us. It also details what our obligations are to you as your Direct Debit Provider. We recommend you keep this agreement in a safe place for future reference. It forms part of the terms and conditions of your Direct Debit Request (DDR) and should be read in conjunction with your DDR form.

Definitions

a) account means the account held at your financial institution from which we are authorised to arrange for funds to be debited.
b) agreement means this Direct Debit Request Service Agreement between you and us.
c) Business means the "business" as referred to on the DDR form.
d) banking day means a day other than a Saturday or a Sunday or a public holiday listed throughout Australia.
e) debit day means the day that payment by you to us is due.
f) debit payment means a particular transaction where a debit is made.
g) direct debit request means the Direct Debit Request between us and you.
h) us or we means NumeroPro, (the Debit User) you have authorised by signing a direct debit request.
i) you means the customer who signed the Direct Debit Request.
j) your financial institution means the financial institution nominated by you on the DDR at which the account is maintained.

I/We hereby authorise NumeroPro Pty Ltd ATF The Kidsoft Unit Trust ABN 17 349 353 404 (herein referred to as "NumeroPro") to make periodic debits on behalf of the "Business" as indicated on the front of this Direct Debit Request (herein referred to as the "Business").

I/We acknowledge that NumeroPro is acting as a Direct Debit Agent for the Business and that NumeroPro does not provide any goods or services and has no express or implied liability in regards to the goods and services provided by the Business or the terms and conditions of any agreement that I/we have with the Business. I/We acknowledge that the debit amount will be debited from my/our account according to the terms and conditions of my/our agreement with the Business. I/We acknowledge that bank account and/or credit card details have been verified against a recent bank statement to ensure accuracy of the details provided and will contact my/our financial institution if I/we are uncertain of the accuracy of these details.

Debiting your account
By signing a Direct Debit Request, you have authorised us to arrange for funds (these amounts may vary upon instructions from the Business) to be debited from your account. You should refer to the Direct Debit Request and this agreement for the terms of the arrangement between us and you. We will only arrange for funds to be debited from your account as authorised in the Direct Debit Request.

If the debit day falls on a day that is not a banking day, we may direct your financial institution to debit your account on the following banking day. If you are unsure about which day your account has or will be debited you should ask your financial institution. I/We acknowledge that any request by me/us to stop or cancel the debit arrangements will be directed to the Business. I/We acknowledge that any disputed debit payments will be directed to the Business and/or NumeroPro. If no resolution is forthcoming, I/we agree to contact my/our financial institution. I/We acknowledge that if a debit is returned by my/our financial institution as unpaid, a failed payment fee is payable. I/We will also be responsible for any fees and charges applied by my financial institution and collection fees, including and not limited to any solicitor fees and collection agent fees appointed by NumeroPro. I/We authorise NumeroPro to attempt to re-process any unsuccessful payments as advised by the Business. I/We acknowledge that if specified by the Business, a setup, variation, SMS or processing fees may apply as instructed by the Business.

Amendments by us
We may vary any details of this agreement or a Direct Debit Request at any time by giving you at least fourteen (14) days written notice.

Amendments by you
You may change, stop or defer a debit payment, or terminate this agreement by providing us with at least fourteen (14) days notification by writing to: PO Box 1298, Broadbeach QLD 4218 or by telephoning us on 1800 827 234 during business hours or arranging it through your own financial institution.

Your obligations
It is your responsibility to ensure that there are sufficient clear funds available in your account to allow a debit payment to be made in accordance with the Direct Debit Request. If there are insufficient clear funds in your account to meet a debit payment:

a) you may be charged a fee and/or interest by your financial institution;
b) you may also incur fees or charges imposed or incurred by us; and
c) you must arrange for the debit payment to be made by another method or arrange for sufficient clear funds to be in your account by an agreed time so that we can process the debit payment.

You should check your account statement to verify that the amounts debited from your account are correct.

If NumeroPro is liable to pay goods and services tax ("GST") on a supply made in connection with this agreement, then you agree to pay NumeroPro on demand an amount equal to the consideration payable for the supply multiplied by the prevailing GST rate.

I/We acknowledge that there may be a delay in processing if:-

a) there is a public or bank holiday on the day, or any day after the debit date; or
b) a payment request is received by NumeroPro on a day that is not a banking business day; or
c) a payment request is received after normal NumeroPro cut off times, being 4:00pm Queensland time, Monday to Friday. Any payments that fall due on any of the above will be processed on the next business day.

Dispute
If you believe that there has been an error in debiting your account, you should notify us directly on 1800 827 234 and confirm that notice in writing with us as soon as possible so that we can resolve your query more quickly. Alternatively you can take it up with your financial institution direct. If we conclude as a result of our investigations that your account has been incorrectly debited we will respond to your query by arranging for your financial institution to adjust your account (including interest and charges) accordingly. We will also notify you in writing of the amount by which your account has been adjusted. If we conclude as a result of our investigations that your account has not been incorrectly debited we will respond to your query by providing you with reasons and any evidence for this finding in writing.

Accounts
You should check:

a) with your financial institution whether direct debiting is available from your account as direct debiting is not available on all accounts offered by financial institutions.
b) your account details which you have provided to us are correct by checking them against a recent account statement; and
c) with your financial institution before completing the Direct Debit Request if you have any queries about how to complete the Direct Debit Request.

Confidentiality
We will keep any information (including your account details) in your Direct Debit Request confidential. We will make reasonable efforts to keep any such information that we have about you secure and to ensure that any of our employees or agents who have access to information about you do not make any unauthorised use, modification, reproduction or disclosure of that information. Further information relating to NumeroPro's Privacy Policy can be found at https://app.kidsoft.com.au/terms/PrivacyPolicy.pdf

We will only disclose information that we have about you:

a) to the extent specifically required by law; or
b) for the purposes of this agreement (including disclosing information in connection with any query or claim).

Credit Card Payments
I/We acknowledge that "Business" will appear as the merchant for all payments from my/our credit card. I/We acknowledge and agree that NumeroPro will not be held liable for any disputed transactions resulting in the non-supply of goods and/or services and that all disputes will be directed to the Business as NumeroPro is acting as a 3rd party payment provider. I/We acknowledge and agree that in the event that a claim is made, NumeroPro will not be liable for the refund of any funds and agree to reimburse NumeroPro for any successful claims made by the Card Holder through their financial institution against NumeroPro. Credit Card Fees are a minimum of the Transaction Fee or the Credit Card Fee whichever is greater. I/We authorise:

a) NumeroPro to verify details of my/our account with my/our financial institution; and
b) My/our financial institution to release information allowing NumeroPro to verify my/our account details.

This Authorisation is to remain in force in accordance with the terms and conditions on this Direct Debit Request, the provided NumeroPro Pty Ltd ATF The Kidsoft Unit Trust DDR Service Agreement, and I/we have read and understood the same.

Direct Debit Authorisation

Signature(s) of Nominated Account Holder/Credit Card Holder*

Date

DD slash MM slash YYYY

ABN: 17 349 353 404 PH: 1800 827 234
Direct Debit Request – New Customer

Business:

ABN/ACN:

First Name:

Surname:

Mobile Phone:

Customer Reference:

Email:

Address

Street Address Suburb / City State / Province Postcode / ZIP Country

Debit Arrangement / Payment Details

Child's Name

Fixed Amount

Variability

Fixed

Variable

Fee Start Date

DD slash MM slash YYYY

Frequency

Weekly

Debit from Bank, Building Society or Credit Union Account

Financial Institution:

Branch:

BSB Number:

Account Number:

Account Holder Names(s):

I/We authorise NumeroPro Pty Ltd ATF The Kidsoft Unit Trust ABN 17 349 353 404 to debit my/our account at the Financial Institution identified above through the Bulk Clearing System (BECS) in accordance with the Payment details stated above and as per the NumeroPro Pty Ltd ATF The Kidsoft Unit Trust DDR Service Agreement (Ver 3.0) provided.

Transaction Fee: $0.79
Failed Transaction Fee: $4.00

By signing and/or providing us with a valid instruction in respect to your Direct Debit Request, you have understood and agreed to the terms and conditions governing the debit arrangements between you and NumeroPro Pty Ltd ATF The Kidsoft Unit Trust as set out in your Direct Debit Request Service Agreement.

Youth Leadership Victoria

Outside School Hours Care

Direct Debit Request (DDR) Authorisation Form (Debit Success)

Direct Debit Request (DDR) Authorisation Form

Centre

Authoriser

Child or Children's Details

Child or Children's Details

Child or Children's Details

Parent / Guardian

Direct Debit Request - Authorisation Form

Customer Details

Account Request Type

Payment Details

Payment Method

Direct Debit from Bank Account, Building Society, or Credit Union

Credit Card

Terms and Conditions

Signature

Payment Method

Debit Arrangement / Payment Details

Debit from Credit Card

Direct Debit Service Agreement

Direct Debit Authorisation

Debit Arrangement / Payment Details

Debit from Bank, Building Society or Credit Union Account