DEBIT ORDER FORM Name of account holder *Address *Bank *Branch code *Account number *Account type *Amount *Date *BeneficiaryName of beneficiary : SA CHILDCAREBeneficiary’s address : 388 Deetlefs Street, Pretoria North Abbreviated name as it will appear on your bank statement : RESACA This signed Authority and Mandate refers to our contract dated *I/We authorize you to issue payment instructions to my/our bank for collection, ensuring the amount does not exceed my/our agreed obligations in the Agreement. This authority remains valid until terminated by written notice of at least 20 working days. *Payment dayThe individual payment instructions so authorised to be issued must be issued and delivered as follows: In the event that the payment day falls on a Sunday or recognized public holiday, the payment day will automatically be the very next ordinary business day. Furthermore, if there are insufficient funds in the (my) nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account; monthly, bi-monthly, three monthly, six-monthly, annually, weekly, bi-weekly or once-off (delete which is not applicable), on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not be more or less than the obligation due. The payment will be made on the day of the month, starting from *Payment Instructions due in December and/or April may be debited against my account on *I /We understand that the withdrawals hereby authorised will be processed through a computerized system provided by the Banks. I also understand that details of each withdrawal will be printed on my Bank statement. Such must contain a number, which number must be included in the said payment instruction and if provided to me should enable me to identify the Agreement. This number must be added to this form in section D before the issuing of any payment instruction.A. MANDATEI/We acknowledge that all payment instructions issued by you shall be treated by my/our above mentioned Bank as if the instructions had been issued by me/us personally.B.CANCELLATIONI/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. I/We shall not be entitled to any refund of amounts which you have withdrawn while this Authority was in force, if such amounts were legally owing to you.C.ASSIGNMENTI/We acknowledge that this authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.D. AGREEMENT REFERENCE NUMBER "FOR OFFICE USE"This agreement reference number is:I am authorized to sign and submit the above document. *YesSend Details DEBIT ORDER FORM Name of account holder *Address *Bank *Branch code *Account number *Account type *Amount *Date *BeneficiaryName of beneficiary : SA CHILDCAREBeneficiary’s address : 388 Deetlefs Street, Pretoria North Abbreviated name as it will appear on your bank statement : RESACA This signed Authority and Mandate refers to our contract dated *I/We authorize you to issue payment instructions to my/our bank for collection, ensuring the amount does not exceed my/our agreed obligations in the Agreement. This authority remains valid until terminated by written notice of at least 20 working days. *Payment dayThe individual payment instructions so authorised to be issued must be issued and delivered as follows: In the event that the payment day falls on a Sunday or recognized public holiday, the payment day will automatically be the very next ordinary business day. Furthermore, if there are insufficient funds in the (my) nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account; monthly, bi-monthly, three monthly, six-monthly, annually, weekly, bi-weekly or once-off (delete which is not applicable), on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not be more or less than the obligation due. The payment will be made on the day of the month, starting from *Payment Instructions due in December and/or April may be debited against my account on *I /We understand that the withdrawals hereby authorised will be processed through a computerized system provided by the Banks. I also understand that details of each withdrawal will be printed on my Bank statement. Such must contain a number, which number must be included in the said payment instruction and if provided to me should enable me to identify the Agreement. This number must be added to this form in section D before the issuing of any payment instruction.A. MANDATEI/We acknowledge that all payment instructions issued by you shall be treated by my/our above mentioned Bank as if the instructions had been issued by me/us personally.B.CANCELLATIONI/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. I/We shall not be entitled to any refund of amounts which you have withdrawn while this Authority was in force, if such amounts were legally owing to you.C.ASSIGNMENTI/We acknowledge that this authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.D. AGREEMENT REFERENCE NUMBER "FOR OFFICE USE"This agreement reference number is:I am authorized to sign and submit the above document. *YesSend Details
