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Debt Mandate Form

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aupapah
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26 views

Debt Mandate Form

Uploaded by

aupapah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PAYMENT INSTRUCTION / DEBIT MANDATE

A. This is my/our instruction to my bank to make payment as stated below and my/our bank can debit my/our bank account.

Authority

Given by (Full Name and surname of Account Holder)

Address

Account Holder’s Bank

Branch Name / Branch Code / BIC Code

Account Number

Account Type

Total amount of deduction authorized by Account Holder

Date of first deduction

To (name of beneficiary) 24516 Elegant Financial Services


Beneficiary’s Address Erf 1377, Brian Simataa Street, Ondangwa 9000
Abbreviated Name as Registered with the Bank RPELEGAN

This signed Authority and Mandate refers to the contract between me/us and the Beneficiary (‘you”) dated_________________________
(“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 obligations as agreed to in the Agreement and commencing on
_____________________________ and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing
of not less than 1 (one) ordinary business days, and sent by prepaid registered post or delivered to your address as indicated above.

The individual payment instructions authorized to be issued must be issued and delivered as follows: monthly / bi-monthly / three monthly
/ six monthly / annually / weekly / bi-weekly (delete that which is not applicable).

In the event that the payment day falls on a Sunday, or recognized public holiday in the Republic of Namibia, the payment day will
automatically be the very next ordinary business day. Furthermore, if there are insufficient funds in my/our account to meet the obligation,
you are entitled to re-represent the instruction for payment to my account for a period of 2 days (One to Fourteen ) Number in words) days.

Due to the customary early payment of salaries in December, I hereby authorize you to present my December payment instructions earlier,
aligned with my salary payment date. Furthermore, if there are insufficient funds in my/our account to meet the December obligation, you
are entitled to re-present the instruction to my/our account for payment as soon as sufficient funds are available for a period of ……… days
(……………………….………………….) Number in words) days.

I/We understand that the payments hereby authorized will be processed through a computerized system provided by the Namibian Banks.
I/We also understand that details of each payment will be printed on my/our bank statement. The bank statement must contain a reference
number for identification, which must be included in the said payment instruction and if provided to me/us should enable me/us to identify
such transaction as linked to this payment instruction authorization. This number must be added to this form in Section F before the issuing
of any payment instruction.
Mandate Form

B. 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.

C. 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 collected while this Authority was in force, if such amounts were legally owing
to you.

D. 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 cession or assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.

E. Declaration

I/We hereby declare as follows:

• I/We have the necessary authority to sign this Mandate Authority.

• The information herein provided to you is true, correct and complete. The information shown above is correct.

• I/We agree to be bound by signing this Mandate Authority.

• By signing this Mandate Authority, I/we agree that any previous Mandate Authorities signed by me/us relating to Agreement Reference
Number: ______________________ is hereby revoked.

Signed at ______________________________ on this _________ day of ____________________ 20_________________.

_______________________________________ ____________________________________________

(Full name and surname of account holder) (Signature as used for operating on the account)

For Official Use:

_______________________________________ (Assisted By)

F. Agreement Reference Number

This Agreement number is: _______________________________________

Elegant Financial Services cc, a subsidiary of Elegant Holdings (Pty) Ltd

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