Corruption Watch: Debit Order Mandate

Electronic debit order mandate

Authority given by:
Name*
Title First Last
ID Type*
- RSA ID
- Other
ID Number*
Other ID*
Date of Birth*
Date Format: MM slash DD slash YYYY
Email Address*
Cell Number*
Find address using Google Maps
Address*
Street Address Complex / Estate, Home Number & Internal Street City State / Province / Region ZIP / Postal Code Country
Bank account details:
Bank*
Branch Code*
Account Number*
Type of Account*
Agreement:
Abbreviated short name as registered with the acquiring bank: CORUPWATCH
Refer to our contract reference number (“the Contract Reference Number”):
Reference*
I want to donate*
- Monthly
- Once-off
Donation Amount*
- R100
- R200
- Other
Donation Amount (Other)*
Please enter a number greater than or equal to 50.
Date for debit to my account*
Date Format: DD slash MM slash YYYY
and thereafter regularly on the:
Monthly debit order day*
Terms and Conditions
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 Corruption Watch 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.
Signature*
Signature verified by Bank

E-Mandate

Electronic debit order mandates for your business.

(LS) #** CW001 – Corruption Watch

Authority given by:

Bank account details:

Agreement: