Get Electronic Funds Transfer Application Form - Worksafe

Filling out the Electronic Funds Transfer Application Form for WorkSafe is essential for facilitating timely and secure payment transactions. This guide will walk you through each section of the form, ensuring a clear understanding of the necessary steps.

Follow the steps to complete your application efficiently.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Enter your postal address in the relevant field to ensure accurate correspondence.
3. Provide your contact telephone number, including area code, in the designated field.
4. Input your email address to receive electronic remittances.
5. Fill in your fax number if applicable.
6. Specify the provider number under your account details.
7. Indicate the type of services you provide.
8. Under bank account details, enter your company name, bank name, and address of your bank or financial institution.
9. Provide the title of the account according to the exact name(s) registered.
10. Fill in the phone number and fax number of the bank if required.
11. If applicable, include the company name or given names for a joint account.
12. Enter the Bank/State/Branch Number (BSB) or Financial Institution Number.
13. Read and acknowledge the collection of personal information notice by WorkSafe.
14. Sign the form as the account holder, including the date of signing.
15. Select your preferred frequency for payment—daily or weekly—and ensure this is indicated in your application.
16. Once all sections are completed, save your changes, download, print, or share the form as needed.

Complete your Electronic Funds Transfer Application online today to ensure seamless payments.