Debit Order Form - Eldo Urban

Please take note that the consent form located on the forms page must be completed before completing this form!

Debit Order Instruction

Authority and Mandate for payments instruction: Electronic and Written Mandates

A. AUTHORITY

Property Name: *

Property Reg. Number: *

Unit Number: *

Name of Account Holder: *

Address: *

Contact Number: *

E-mail Address: *

Bank Information:

Bank: *

Branch Code:

Account Number: *

Type of Account Current: *

Amount: *

Date *

Year

Month

Day

To (Name of beneficiary) ELDO URBAN NPC

Trust Account Number: *

Abbreviated name:

Beneficiary Address: *

This signed Authority and Mandate refers to our contract dated [select date] ("the Agreement"). I/ We hereby authorize you to issue and deliver payment instructions to your Banker for collection against my/ our above-mentioned account at my/ our above-mentioned Bank (or any other bank or branch to which I/ we may transfer my/ our account) on condition that the sum of such payment instructions will never exceed my/ our obligation as agreed to in the Agreement and commencing on 1st of 20 and continuing until this Authority and Mandate is terminated by me/ us by giving you notice in writing of not less than 20 ordinary working days, and sent by registered post or electronic mail or delivered to your address as indicated above. *

Year

Month

Day

Date nominated for collection against my bank account: *

If the payment day falls on a Sunday, or recognized South African public holiday, the payment day will automatically be the following ordinary business day. *I/We understand that the withdrawals hereby authorized will be processed through a computerized system provided by the South African Banks. I also understand that details of each withdrawal will have “ELDO URBAN” printed on my bank statement as reference.I/We herewith attach a confirmation of banking details to confirm that all details as given above is correct.I/ We herewith attach confirmation that I/ we have signing authority on the above-mentioned account (if applicable).B. CHARGES: I/We confirm that should my debit order fail for any reason, a bank/ administrative fee may be debited to my/ our levy account.C. MANDATE: I/We acknowledge that all payment instructions issued by you shall be treated by my/ our above-mentioned Bank as if the instructions have been issued by me/ us personally.D. 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 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 you.E. 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, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.

Signed at: *

on this date *

Year

Month

Day

F. AGREEMENT REFERENCE NUMBER *This agreement reference number is (levy account no.):

l agree that the information submitted in this form is 100% correct and may be verified with my levy account & bank and by checking the box below act as my digital signature: NOTE: Checking this checkbox and submitting the form will result in your digital signed consent being sent to the interim committee which gives them your consent to debit your account as agreed upon above. *Please Sign Here