Check-off form (to be submitted with your application form) Please complete in capital letters
SURNAME_________________________________________ INITIALS____________________
ADDRESS______________________________________________________________________________________
_________________________________________________________________
POSTCODE_____________________
EMPLOYERS NAME ________________ DEPARTMENT_____________________________
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 a
union 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 Subscription rate OVER 20 £10.96 Under 20 or Part-time £4.98 (inclusive of political levy)
_______________________________For Branch Use only________________________________________
Monthly Payment to be deducted £ ______________