Check-off form [to be submitted with your application form] Please complete in capital letters:

SURNAME_________________________________________   INITIALS____________________

ADDRESS________________________________________________________________________

___________________________________________________ POSTCODE___________________

EMPLOYERS NAME _________________________       DEPT_____________________________

STAFF NO (IF KNOWN)_________________      GRADE________________________ 

To: Salaries Department:
I instruct you to deduct from my salary, until further notice, the current monthly/weekly subscription to be paid to the Tayside Educational Branch of Amicus on my behalf.
If the subscription should be varied the deduction be varied accordingly. I also authorise my home address to be given to Amicus as a matter of information.

Signature___________________________           Date_____________________________

The Political Levy is important to Amicus and to our parliamentary work. It helps us protect your interests through legislation initiated by our parliamentary committee.
It also finances all the lobbying that as become so necessary today. You are entitled to contract out of paying the political levy.
If you do so you surrender no rights as aunion member except you cannot vote on how the political fund is spent. But in these changing times
we need our parliamentary arm. If you do not agree with us and do not wish to pay the political levy then put a ‘NO’ here ___________ 

Current rate OVER 20 core £11.48 Under 20 or Part-time core £5.72 (inclusive of political levy)    OPTION 1 YES/NO

OR New options core plus ancillary benefits £12.13 or £6.07 (inclusive of political levy)              OPTION 2 YES/NO

______________________________For Branch Use only__________________________________

Monthly Payment to be deducted £ _______