The Goedgedacht Trust: Electronic Debit Order Mandate

DEBIT ORDER INSTRUCTION

Location*
Authority given by:
Name*
First Last
ID Number*
Date of Birth
Date Format: MM slash DD slash YYYY
Mobile Number*
Email Address*
Address*
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bank account details:
Account holder name*
Bank*
Branch code*
Account number*
Type of account*
Agreement:
Abbreviated short name as registered with the acquiring bank: GOEDGEDACH
Refer to our donation reference number (“the Reference Number”):
Reference Number*
Donation Amount*
- R125
- R200
- R250
- R500
- Other
Donation Amount (Other)*
Please enter a number greater than or equal to 125.
Start date for first debit to my account*
Date Format: DD slash MM slash YYYY
and thereafter regularly on the:
Monthly debit order day*
Terms of agreement
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 The Goedgedacht Trust may be recovered of unmet transactions. If the payment day falls on a Sunday or recognised South African public holiday, the payment will automatically be processed the next ordinary business day. I authorise the originator to make use of the tracking facility as provided for in the EDO system at no additional cost to myself. 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.
Signature*
Signature verified by Bank

E-Mandate

Electronic debit order mandates for your business.

(LS) #65 TGT001 – THE GOEDGEDACHT TRUST

DEBIT ORDER INSTRUCTION

Authority given by:

Bank account details:

Agreement: