LONDON OFFICE PAYMENT MANDATE For clients paying in Pounds Sterling

The following cards are accepted for payment in Pounds Sterling: Maestro Debit Card, Mastercard Credit Card, Solo Debit Card or Visa Debit and Credit Card.

If you wish to pay by Credit Card in Australian Dollars please complete the payment section on the application form. Mastercard Credit Card, Visa Credit Card, American Express Credit Card, Diners Credit Card, JCB Credit Card are accepted for payment in Australian Dollars. Please note that if paying by credit card in Australian Dollars you may incur banking and currency conversion fees and you accept the risk associated with any currency fluctuations.

The charges (fees) change on 1 January and 1 July as a result of the biannual foreign exchange rate indexation. By signing this form, you are authorising us to deduct the charge (fee) as indicated at www.immi.gov.au as applicable on the date on which we receive the correct application form and payment.

Applicant Details

FAMILY NAME

FORENAMES

DATE OF BIRTH / / (DDMMYY)

FILE REFERENCE (IF ANY)

CASE OFFICER NAME (IF ANY)

PHONE NO. (INCLUDING STD)

ADDRESS

Application charge amount

TOTAL AMOUNT PAYABLE £

Payment Details

 CARD TYPE MASTERCARD Credit Card  (TICK ONE ONLY) VISA Credit or Debit Card  SOLO Debit Card  MAESTRO Debit Card 

CARD NUMBER

CARD EXPIRY / / (DDMMYY)

CARD ISSUE* / / (DDMMYY) *WHERE APPLICABLE

ISSUE NO.* *MAESTRO ONLY

CARD VERIFICATION NUMBER (3 digits)

NAME ON CARD

CARDHOLDER SIGNATURE