Branch Bank Account Details Form for Repayment of the Branch Levy By completing this form you are confirming that your branch is opting into the BSAC direct debit branch levy scheme. This means that BSAC will be collecting your branch levy from your members by annual or monthly direct debit on your behalf and returning the amount collected to the branch bank account detailed below on a monthly basis. Please note that members wishing to opt in to this scheme must also have their BSAC subscription collected by annual direct debit or be BSAC Life members.

Branch name …………………………….…………...……………………………………………..………………………………………..… Branch number ……….……………..….. Contact name……………..………………………………………….……………………………………..……………..……………………………………................................................ Contact tel no ……………………………………………………………………….…………… Mobile ………………………………………………………………….…………………….....

Membership No: A…..………………………..…. Email Address ………………………………………………………………………………..…………………………….………… Branch Levy Common Renewal Date (If applicable) Please select one of the following monthly instalments for the collection of branch levy from your club members. Annual 3 Instalments 6 Instalments 10 Instalments 12 Instalments

Bank/Building Society Address Postcode

British Sub-Aqua Club

Bank/Building Society account number Name(s) of Account Holder(s)

Name and full postal address of your Bank or Building Society

Bank Sort Code

Branch Levy Information Form. We will need to know the amount of branch levy that your branch charges for each membership category and what will be availble to new, all and renewals/rejoining members. Membership Category Total Branch Levy Amount Renewals/Rejoin New members All Members ………………………………é £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £………………………… ………………………………… £…………………………

Once you have completed the form please select the submit button and this will be sent to BSAC. You will be contacted once you application has been processed.