HESTA member direct debit request form and service agreement

This form enables you to set up direct debit contributions from your after-tax pay into your HESTA super account.

We have tried to make it easier for you to fill in the form. Once you download the PDF version you can enter your details online into the fields then just print the form and sign. Please ensure that you have signed and dated the declaration and that all certified documentation is attached (if applicable) then mail to: HESTA, PO Box 600, Carlton South Vic 3053.

Do not email this document as we will be unable to accept it without your signature.

Our forms are available in PDF (Portable Document Format). If you do not have the Acrobat reader that is required to view the PDF files, you can download it here. Remember to keep a hard copy of any booklets or forms that you use for your records.

You should receive a total of 4 pages if printing the PDF version of this document. Document size: 77KB

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1. Right-click (Mac users click-and-hold) anywhere on the 'download file' link.
2. Choose 'Save Target As' or 'Save Link As' from the menu.
3.Choose a location to save the image; then click 'Save'. To open these documents you must have version 4 or later of the Adobe Acrobat Reader software installed.