Embed Size (px)
Citation preview
2018 Staff Application for Parking Permit DeductionsAll fields are mandatory – except alternate vehicle details
Print, sign and scan this form to the University Parking team at [email protected]
ORGANISATION WESTERN SYDNEY UNIVERSITY WESTERN SYDNEY
UNIVERSITY THE COLLEGE
NEW UPGRADING DOWNGRADING
EMPLOYEE NUMBER EMAIL:
SURNAME FIRST NAME
POSTAL ADDRESS
CONTACT NUMBERS Extn: Mobile: Fax:
COLLEGE / DIVISION School/Unit: Building: Room:
PRIMARY CAMPUS
Bankstown Campbelltown Hawkesbury Kingswood Parramatta South Parramatta North Parramatta City Werrington North Werrington South Blacktown/Nirimba Westmead Homebush
VEHICLE DETAILSReg No: Make: Model:
Reg No: Make: Model:
PERMIT TYPERed permits will be issued subject to availability Red approval number
DESCRIPTION FORTNIGHTLY FEE Inc GST General Yellow (annual only) $7.74
Communal Blue (annual only) $11.58
Dedicated Red $29.82
Dedicated Red with Bollard $33.85
PAYMENT METHOD Salary Sacrifice (Pre Tax) as per your nominated permit preference
above Salary Deduction (After Tax) as per your nominated permit preference
abovePayment and parking application authority
I hereby authorise Western Sydney University to deduct from my fortnightly salary the amount shown above as nominated by me. This authority is to continue until such time as it is withdrawn by me in writing. I understand that I am responsible for any traffic and parking infringement notices. I agree to abide by the Parking and Traffic Policy including any future amendments to the policy. Please note that parking fees will be subject to annual CPI increases.
Signature: Date:
Note: Parking fees are non refundable.Print, sign and scan this form to the University Parking team at [email protected]
OFFICE USE ONLY
Eligibility Check Scanned Entered Permit Number
