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Payer details are different from main member
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Your Title
DR
MR
MRS
MS
MISS
Name
Surname
ID Number
Date Of Birth
Street Address
City
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Postal Code
Home Tel
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Cell
Email
Employers Name
Job Description
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Debit Order Date
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25th
Date of first debit order
Amount
By checking this box, I hereby authorise you to issue and deliver payment instructions to your banker for collection against my account. I understand that: The withdrawals authorised will be processed through a computerised system provided by South African Banks. Details of each withdrawal will appear on my bank statement. Receipt of this instruction by you is regarded as receipt by my bank. If the payment date falls on a non-processing day (e.g., Sunday or public holiday), the amount may be debited on the following business day.
MANDATE: I acknowledge that all payment instructions issued by you will be treated as if they were issued by me personally.
CANCELLATION: I understand that although I may cancel this authority, such cancellation will not cancel any existing agreement. I also understand that I cannot reclaim amounts legally owing that have been withdrawn in terms of this mandate. Written notice of cancellation must be received at least one calendar month in advance.
ASSIGNMENT: I acknowledge that this authority may be ceded or assigned to a third party if the related agreement is also ceded or assigned.
FEE: I authorise you to debit my account with the fee applicable to my selected plan on a monthly basis. I agree that fee variations may occur without prior notice to cover increases in charges.
BANK CHARGES: I agree to pay any bank charges associated with this debit order instruction.
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