B OARDCOMMITTEE MEMBER PAYMENT INSTRUCTION FORM INFORMATION COLLECTED ON

B OARDCOMMITTEE MEMBER PAYMENT INSTRUCTION FORM INFORMATION COLLECTED ON
E 7 BOARDCOMMITTEETRIBUNAL MEMBER SUPERANNUATION SALARY SACRIFICE FORM INSTRUCTIONS





Board/Committee Member Payment Instruction Form





BB OARDCOMMITTEE MEMBER PAYMENT INSTRUCTION FORM INFORMATION COLLECTED ON oard/Committee Member
Payment Instruction Form

Information collected on this form is used by Shared Services on behalf of ACT Public Service agencies. Information collected will only be used for the purpose for which you gave it and will not be disclosed to any person, body or directorate except where required by law.

Personal Details

Title:      

Family Name:      

Given Names:      

Date of Birth:   /  /    

Residential Address:

     

Postal Address (if different from residential):

     

Phone 1:      

Phone 2:      

Email:      

AGS or Employee Number (if known):      

Bank Account Details (account where any remuneration can be paid into)

Bank/Credit Union:      

Account Name:      

BSB Number:      

Account Number:      

Mandatory Documents - Board/Committee Member Checklist

You must complete and return these documents to your directorate contact person with this form:

Superannuation Acknowledgement and Election forms

Tax File Number Declaration form

Mandatory Evidentiary Documents – you must provide a certified true copy (i.e. original document sighted, copied and signed by a Justice of the Peace, Police Officer or a Public Servant with 5 years service) of the following documentation:

Proof of Date of Birth

Birth Certificate or a Current Passport

Proof of Change of Name

Marriage Certificate, Change of Name Deed Poll or Decree Nisi

Proof of Australian Citizenship

Persons with residency status may apply for Permanent Employment in the ACTPS.

Persons without residency status may be eligible to apply for temporary or casual employment depending on the provisions of their Visa.

Qualifications and Registration Certifications

Agencies may wish to sight original documents for positions that require qualifications or registration.



Directorate Delegate to Complete

Name of Board/Committee:      

Position Number:       Note: If a position number has not been established your directorate must action an Establishment Variation Authority form

Term of Appointment:   /  /     to   /  /     (specify dates)

Annual Salary/Per Diem: (please specify $ amount) $     

I certify that the Board/Committee member has been engaged in accordance with the ACTPS Boards and Committees Handbook (CMTEDD Office) and the ACT Remuneration Tribunal Classification Guidelines and Remuneration determination (www.cmd.act.gov.au/governance/remtrib/determinations):

Delegate Name:      

Title:      

Signature:      

Date:   /  /    

Directorate:      

Directorate Contact Officer:      

Phone No:      

To avoid delays with processing, please ensure directorate contact officer details are provided.

Shared Services Recruitment Officer to Complete

Mandatory documents completed

Date:   /  /    

AGS issued

Signature:


Forward Board/Committee Commencement Package to Shared Services:

Scan and email: [email protected]

Internal mail: HR Service Desk, GPO Box 158, Canberra ACT 2601

Version 2.0 Issued: 1/9/2014 Page 2 of 2





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