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Newcastle Centre

Parish Direct Debit Request

St Mary’s Mission Newcastle

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Direct Debit Request (CDF)

Please complete all required fields below

🔐 Identity Verification

To protect parish families from fraud and ensure Direct Debit changes are made only by the correct account holder, we ask registered families to verify their identity before completing this form.

How this works:

Select your registered family from the list below.
We will show your registered name, and a partially masked email and mobile number so you can confirm it is you.
Click Send OTP and enter the 6-digit code sent to your registered email.
Once verified, you can continue to complete the Direct Debit Request.

👪 Select Your Registered Family(Required)

Please select your family from the list, then confirm your details below.

Registered Name

Registered Email (masked)

Registered Mobile (masked)

⚠️ A Direct Debit Request has already been submitted for this family.

If you need to update your bank details or believe this is a mistake, please contact the parish office directly — this form cannot be submitted again for the same family online.

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Family Code

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Email (OTP Destination)

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Mobile (OTP source)

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DD Submitted Flag

One-Time Password

Password verified.

Kindly verify your details by clicking the 'Send OTP' button. An OTP code will be generated and sent to your registered email. Please enter the OTP below to validate your identity before completing the Direct Debit Request. ✅

👤 Your Details

Name(Required)

First Last

Email(Required)

Work phone number

Mobile phone number(Required)

Address(Required)

Street Address ZIP / Postal Code

💳 Payment Details

Parish Name(Required)

First Collection ($)(Required)

Frequency (First Collection)(Required)

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Second Collection ($)

Frequency (Second Collection)

First payment date(Required)

Until further notice

Debit until further notice

Final payment date

Parish Family Code(Required)

🏦 Financial Institution Details

Name and address of financial institution(Required)

Postcode

💳 Details of Account to Be Debited

Account in the name of(Required)

BSB number(Required)

Account number(Required)

✍️ Signature(s)

Parish Direct Debit Request – Signature Declaration

Before signing this section, please read the Service Agreement on the reverse. Your signature below will indicate you accept the terms of the Service Agreement and confirm that the details on this form have been checked and are correct.

If a joint account, please have all account holders sign. If the account is held by a company secretary, please have one director and the company secretary each sign.

If you are signing for and on behalf of another person or entity, please state the capacity in which you sign, in the signature box below.

Service Agreement

Please review the full Service Agreement before signing below.

View Service Agreement

Agreement(Required)

I have read and agree to the Direct Debit Request Service Agreement.

Signature 1(Required)

Date (Signature 1)(Required)

Signature 2 (if joint account)

Date (Signature 2)

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