Debit Order Form- Open Window Institute

AGREEMENT

Debit Order Form

Kindly complete the form below

Section A: Student Details
Name*
First Last
ID Number*
Passport Number
OW Student number (If Applicable)
Section B: Account Holder Information
Name*
First Last
ID Number*
Passport Number
Relation to Student*
Mobile*
Phone (Home)*
Account Holder Cellphone Number*
Account Holder Email*
Section C: Debit Order Information
Bank*
Other Bank
Branch Code*
Account Number*
Account Type*
Amount per Month*
Day of the Month*
10 Payments commencing from March to December. This signed Authority and Mandate refers to our contract dated (“the Agreement”). I/We hereby authorise 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
Date*
DD slash MM slash YYYY

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 prepaid registered post or delivered to your address as indicated above. The individual payment instructions so authorised to be issued must be issued and delivered as follows: monthly. In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the preceding ordinary business day. Further, if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account; Payment Instructions due in December may be debited against my account on
Date*
DD slash MM slash YYYY

I / We understand that the withdrawals hereby authorized will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction.

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.

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.

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.
Account holder Signature*
Section D: Terms and Conditions
By signing this form, you are deemed to have read and agreed to the terms and conditions of The Open Window as it appears on the online registration form. I indicate the residential address as provided in the online registration form is the address where the service of all documents relating to this matter will be accepted. I declare that the postal address as provided in the online registration form can be used as the postal address to which all correspondence will be sent to me.
Signed at (place)*
Date*
DD slash MM slash YYYY
Account holder/ Guarantor Signature*
By ticking this box, you confirm that you have read and accept our Privacy Policy.*
- I accept the Privacy Policy

AGREEMENT

Debit Order Form

Section A: Student Details

Section B: Account Holder Information

Section C: Debit Order Information

Section D: Terms and Conditions