Higher Education Branch for Tayside & Fife SC/0228M - Check-off form

     To be completed and returned with your application form if not paying by Direct Debit

Mr/Mrs/Ms/Miss/Other ___________________

Surname ___________________________ First Name ___________________

     Address ________________________________________________________


Town ___________________________________________________________

Postcode __________________

Employer's Name ______________________________________________

     Staff No [if known] _______________ Dept_____________________________

     To: Salaries Department

     I instruct you to deduct from my salary, until further notice, the current monthly/weekly

     subscription to be deducted on my behalf. If the subscription should be varied the deduction

should be varied accordingly. I authorise my home address to be given to Unite as a matter of


    Signature ________________________    Date _________________________

_______________________ for branch use only___________________________