Forms

[]

1 Step 1

DAISY DAY NURSERY

Notice to change payment arrangement

Please use this form if you wish to change payment arrangements (eg if you wish to pay part of your fees by voucher or change the voucher amount).

It must be received by the fees manager by the 15th of the month in order to be effective from the 1st of the following month.

EG1: Form received on 09th Jan - change of payment arrangement will be effective from 1st Feb.

EG2: Form received on 16th Jan - change of payment arrangement will be effective from 1st Mar.

All fees are due on the 1^st of the month for which they are due, including vouchers.

Reason for change (tick ALL that apply):

Introduction of childcare voucher payment

Addition of childcare voucher payment

Amendment to AMOUNT on EXISTING childcare voucher payment

Deletion of childcare voucher payment

Change in bank account details (please also submit a direct debit mandate)

Tax Free Childcare

30hrs Free childcare Offer

Please fill in all below sections that relate to your voucher

Daisy Day Nursery Acc Number (Barry)	Daisy Day Nursery Acc Number (Llanishen)	Amount per month £	Effective from 1st of (please enter month)	Name of parent so we can match the payment to the correct child
					×

(1)

Other

Other Voucher

Childs Name

Parents Signature

(Sign Here)

Clear Signature

Dateof appointment

Parents Print Name

For office use only

Manager Signature

(Sign Here)

Clear Signature

Date Receievedof appointment

Change Effective From

New Payment Plan Added