E-Mandate

Electronic debit order mandates for your business.

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(LS) #48 AA010 – ACTION AID (WEB)

Electronic debit order mandate

OTP Verification
Authority given by:
Name*
Title First Last
Email Address*
Cellphone Number*
Alternative Number
ID Type*
- RSA ID
- Other
ID Number*
Other ID*
Date of Birth*
Date Format: DD slash MM slash YYYY
Gender
- Male
- Female
Communication*
- Email
- Mail
Find address using Google Maps
Address
Street Address Complex / Estate, Home Number & Internal Street City State / Province / Region ZIP / Postal Code Country
Employment Status
Payment method:
Pay Using?*
Bank account details:
Bank*
Branch Code*
Account Number*
Type of Account*
Credit card details:
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Agreement:
Abbreviated short name as registered with the acquiring bank: ACTIONAID
Refer to our contract reference number (“the Contract Reference Number”):
Reference*
I want to donate*
- Monthly
- Once-off
Contract Amount*
This is the amount that will be donated to Action Aid.
Monthly debit order date starting from*
Date Format: DD slash MM slash YYYY
Beneficiary’s address: ActionAid South Africa (AASA) Office - Johannesburg, South Africa 4th floor West Wing, 158 Jan Smuts Ave, (Entrance on Walters Avenue) Rosebank, 2196. Telephone: +27 (0) 11 731 4500
I hereby authorise you to issue and deliver payment instructions to your banker for collection against my above mentioned account at my above mentioned bank (or any other bank or branch to which I may transfer my account) on condition that the sum of such payment instructions will never exceed my obligations as agreed to in the donation agreement and commencing on the payment date as selected above and continuing until this authority and mandate is terminated by me by giving you notice in writing of not less than 20 ordinary working days, and sent by email.
I understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks and I also understand that the details of each withdrawal will be printed on my bank statement. I understand that my bank will apply charges at their ruling rates for unmet transactions. I also understand that any banking fees incurred by AASA may be recovered of unmet transactions.
If the payment day falls on a Saturday, Sunday or recognised South African public holiday, the payment will automatically be processed the next ordinary business day.
ASSIGNMENT
I 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.
CANCELLATION
I agree that although this Authority and Mandate may be cancelled by me, I shall not be entitled to any refunds of amounts which you have withdrawn while this authority was in force if such amounts were legally owing to you. I understand that cancellations may only take effect a month later.
Keeping you informed is important to AASA. We like to let our supporters know how their donations are helping to achieve lasting change in communities.
Updates Subscription
- Please tick here to confirm you wish to receive communication from AASA a few times a year. Please note, we will need to send you your tax receipt which is TAX deductible as well as regular updates on how your donation is helping women and children!
www.actionaid.org/south-africa
Privacy Policy*
On behalf of Children and their Communities, Thank You! …for agreeing to support AASA each month.
If you have any questions or wish to make any changes to the information you have provided on this form please Call us on Tel: 011 731 4500 or E-mail us at: [email protected]ctionaid.org
AASA is a non-profit organisation registered in the Republic of South Africa under registration number 2014/226941/08 serves as the data controller of your information from the date you complete this form (or an electronic equivalent). We will safeguard any personal information acquired by us in connection with your use of this donor form or via electronic device by upholding the privacy principles and procedures set out below.
By signing the donor form or providing information via an electronic device, you are accepting the terms of this Privacy & Security Statement and you consent to the collection, processing, further processing and storage of your personal information as contemplated in this Privacy & Security Statement.
The use and collection of private information
While we will retain certain personal information we have collected only for as long as necessary given the purpose for which it was collected, we may store information for the purposes of transaction processing and administration, and to communicate with you directly, and you expressly consent to this.
Sharing information
AASA does not sell, rent or trade your personal information with anyone. AASA will, however, disclose information when required to do so: (1) by a court order, (2) by any regulatory authority (3) in order to comply with AASA's legal and regulatory obligations in terms of any legislation or regulation applicable to AASA and its business dealings (including fraud prevention and anti-money laundering), (4) in the public interest.
Security
AASA takes every reasonable step to protect your personal information, including the use of encryption technology. We can, however, not guarantee the security of any information you transmit to us electronically and you do so at your own risk.
We implement strict security standards and procedures in order to help prevent unauthorised access to your personal information. Only authorised AASA employees or agents will have access to your information, and all of our employees, and associates are held to stringent standards of privacy and security and are bound by confidentiality agreements.
- I accept this is a monthly debit order to my account.
Signature*
Signature verified by Bank

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