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I, the undersigned hereby authorise Jakaranda Children’s Home to debit the following account with the amount specified below in aid of Jakaranda Child and Family Care Centre – Friendship Circle Debit order Project.

MY BANKING DETAILS

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Account Type (Savings, Transmission, cheque etc.)(required)

Kindly debit my above-mentioned account with the following amount on a monthly basis:
otherR100 pmR150 pmR200 pmR250 pmR300 pmR500 pmR1000 pm

OTHER AMOUNT

The first payment to be effective on * (Date) (required)

Date of monthly payment thereafter * (required)

UNTIL THIS AUTHORITY IS CANCELLED BY ME IN WRITING. I confirm that I shall have no claim of whatever nature against Jakaranda Children’s Home's, or the Bank or in the event of the Bank's inadvertent failure to make payment on the due date or otherwise to comply with the provisions thereof. I hereby acknowledge that the above statement and information is correct and true.

TERMS & CONDITIONS:
By completing and submitting the form above, and continuing (as the case may be) from my/our account, at the abovementioned bank (or any other bank or branch to which I/We may transfer my/our account). All such withdrawals from my/our bank account by you shall be treated as though they had been signed by me/us personally. I/We understand that the withdrawals hereby authorized will be processed by a computer, and I also understand that details of each withdrawal will be printed on my bank statement or on an accompanying voucher. I/We agree to pay any bank charges relating to this debit orders instruction. This authority may be cancelled by me/us by giving you 30 days notice in writing, sent by email only to info@jacarandachidren.co.za, but I/We understand that I/We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force if such amounts were legally owing to you. Receipt of this instruction by you shall be regarded as receipt thereof by my/our bank (whichever it is or will be) I/We hereby acknowledge that the party hereby authorized 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 written consent and that 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 authorized party.

I consent to the conditions.

This Electronic form shall be treated as though it had been signed by me personally

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