Joburg Child Welfare: Electronic Debit Order Mandate

Electronic debit order mandate for a once-off or monthly donation to Joburg Child Welfare

Email address*
Enter email address Confirm email address
Authority given by:
First name*
Surname*
Date of birth*
Date Format: DD slash MM slash YYYY
Town/city of residence*
Cell no.*
Payment Method*
Bank account details:
South Africa only.
Select your bank*
Branch code*
Account number*
Type of account*
Credit card details:
Credit Card*

MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Agreement:
Abbreviated short name as registered with the acquiring bank: CHILD WELF
Reference*
Your reference number will be generated on submission.
I want to donate*
Contract Amount*
Annual escallation
- Please increase my donation by 10% every year.
Mandate
I/We hereby authorise CHILD WELF to issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my/our abovementioned bank on condition that the sum of such payment instructions will not differ from my/our obligations as agreed to in the Contract Reference Number. The individual payment instructions so authorised must be issued and delivered on the date when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the Agreement. I/We agree that the first payment instruction will be issued and delivered on:
Start date for debit(s) to my account*
Date Format: DD slash MM slash YYYY
and thereafter regularly on the:
Monthly debit order day (please select)*
of each month.
Terms of agreement
If the date of the payment instruction falls on a weekend or public holiday, I agree that the payment may be debited against my account on the following business day; or subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the Agreement have been paid or until this authority is cancelled by me/us by giving you notice in writing of not less than the interval (as indicated in the previous clause) and sent by prepaid registered post to Joburg Child Welfare, P O Box 62606, Marshalltown, 2107. Mandate I/We acknowledge that all payment instructions issued by you shall be treated by my/our abovementioned bank as if the instructions had been issued by me/us personally. Cancellation I/We agree that although this authority and mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. I/We also understand that I/we cannot reclaim amounts, which have been withdrawn from my/our account (paid) in terms of this authority and mandate if such amounts were legally owing to you. Assignment I/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.
Newsletter
- Please send me updates and news about Joburg Child Welfare work.
Signature*
Signature verified by Bank

E-Mandate

Electronic debit order mandates for your business.

(LS) #** CW001 – JOBURG CHILD WELFARE

Authority given by:

Bank account details:

Credit card details:

Agreement: