FER004

Post: GPO Box X2293 PERTH WA 6847

Centrelink Centrepay Deductions Phone: 1300 650 235 (from landlines) or
Fines, Penalties and Infringement Notices Enforcement Act 1994 (08) 9235 0235 (from mobiles)
Fax: (08) 9425 7070
Fines Enforcement Registry Reference Number 555059656T Email: ferttp@justice.wa.gov.au

Your Services Australia (CRN): 6071632843

details
Full name: brayden peter mark leeson
Address 4650 hopetoun ravensthorpe road
Suburb ravensthorpe Postcode: 6346 State: wa
Date of birth 02/11/1994 Phone: 0439825146
Email: leesonbrayden@gmail.com
Driver’s licence no: 6100015 Vehicle licence no:

Centrepay I authorise Services Australia to make a Deduction of $ 50 a fortnight from my

Deduction jobseeker
(specify which Centrelink benefit) ______________________________________
Authority
benefit and pay this amount to the Fines Enforcement Registry (FER) to pay fines
and/or infringements in the name of (specify FER client name)
brayden peter mark leeson
____________________________________ commencing from17 /04 / 2024 .
Option 1 – I request that this deduction of $ a fortnight continue until the target amount of
Target
$ is reached and understand that no further funds will be deducted and paid
amount
towards the debt for ________________________________.
*Note: If a deduction has a target amount set, the final deduction will increase by up to $2 to cover
any remaining amount of less than $2.
Option 2 – I request that this deduction of $ 50 a fortnight continue until all my fines and/or
No target infringements are paid in full. I confirm that this deduction has no target amount or
amount end date.
Applicant I give permission for the Fines Enforcement Registry to disclose my information to the Department of
permission Human Services for the purposes of checking my account number, billing number and amount I want
to pay, and reconciling my payment Deduction details.

I understand that I can change or cancel my deduction at any time, and further information about
Centrepay can be found online at www.humanservices.gov.au/centrepay. Australian privacy
legislation protects your personal information.
Signature Date 06/04/2024
of
applicant

Completed signed forms can either be emailed to: ferttp@justice.wa.gov.au or posted to GPO Box
X2293, PERTH WA 6847.

Important: This is an application only and you should not begin driving until you receive written
confirmation from the Registrar that your application has been approved and your licence suspension
has been lifted. You may also be subject to other restrictions on your licence and you are advised to
check the status of your licence with the Department of Transport.

Centrelink Centrepay Deductions – July 2022 Page 1 of 1