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For your protection, please use a username and password that you are not using for any other purposes.
I/We hereby give Independent Broker Lifestyle Solutions permission to make use of any approved third party debit order facility. I/We hereby declare that I/we have loaded all my/our details correctly for the monthly debit order to be collected. I/We hereby request and authorise you to draw against my/our account with the above mentioned bank the sum of R30.00. An administration fee of R2.50 shall be charged upon each transaction.
I/We agree to have the above amount debited on the
day of every month, commencement date
/
/ 200
.
If, however any transfer of funds is unsuccessful, I/we understand that a penalty of R7.50 (incl. VAT) will be levied when the next debit order run is due. All such withdrawals from my/our bank account by you shall be treated as though they have been signed by me/us personally. This authority may be cancelled by me/us by giving you 30 days notice in writing. I/we understand that I/we shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force if such amounts were legally owing to Independent Broker Lifestyle Solutions. Receipt of this instruction by you shall be regarded as receipt thereof by my/our bank (whichever it is or will be). No pro-rata payments are applicable. Only full payment in respect of services is accepted.
The service will only be activated after receiving the first payment.
ASSIGNMENT:
I/we acknowledge that the party hereby authorised to effect the drawing(s) against my/our account may not cede or assign any of its rights to any third party without my/our prior written consent. I/we may not delegate any of my/our obligations in terms of this contract authority to any third party without prior written consent of the authorised party.
By accepting the terms and conditions below I/we hereby accept that this is an electronically-signed debit order. All correspondence will be send electronically.
Please check the fields above and make sure that all the information is correct.
All fields are required. Please make sure that all personal details are updated at all times to ensure continuous cover. This can be done by login onto the mall.
You will be notified within 24 working hours regarding your registration.
I have read and accept the
terms and conditions
.
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