Only complete this section if you are an Agency Worker, ie, your post in the NICS was through a Recruitment Agency.Do not complete this section if you are directly employed by NICS.
hereby authorise and request you to debit
bank account as below with the sum of:
and credit: NIPSA No. 2 Account Number: 20157289 Sort code: 60-83-01 Unity Trust Bank, 4 Brindley Place, Birmingham B1 2JB
on the 2nd of
and on the 2nd day of each month thereafter until further notice in writing. It is understood that the bank shall not be under any liability for damage or loss caused by any omission to make these payments.
I declare to the best of my knowledge the answers to the above questions are correct. If my application is accepted, I agree to abide by the rules of NIPSA and authorise the deduction from my salary of the appropriate subscription.
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