Fortnightly Contribution

Payroll deduction authority - Protecting the Protectors Limited

I authorise the Pay Branch, Victoria Police to deduct the fortnightly amount indicated below from my pay and to remit it to Protecting the Protectors Limited (ABN 18 685 506 503). This authority continues until I cancel or vary it in writing.

Member details

Name

Employee no.

Rank

VP number (for reference)

Station / work unit

Deduction details

Fortnightly amount (select one)

$10

$20

Other

Other amount per fortnight ($)

Deductions to commence fromFirst available pay period on or after this date.

Authorisation

Signature

Use a finger, stylus or mouse to sign in the box.

Date

Please complete and return this form to

Protecting the Protectors Limited32/328 Reserve Road
Cheltenham VIC 3192
Email: glenn.holland@protectingtheprotectors.org.au
Phone: 0425 876 067

For payroll processing (Victoria Police)Corporate Payroll Unit - HRD, Level 25
Tower 1 - VPC, 311 Spencer Street
Docklands VIC 3008
Email: Payroll-Services-Mgr@police.vic.gov.au

Thank you for supporting Victoria Police members and veterans suffering from PTSD and mental health challenges.

Personal information collected on this form is used solely to administer your payroll deduction and donation to Protecting the Protectors Limited.