Authorisation to bank
I/We hereby request and authorize you or your authorized agent to debit the necessary amount for payment of the monthly membership premium to my/our account to the above bank
(or any other bank/branch to which I/we may transfer my/our account). All such withdrawals from my/our bank account will be deemed to have been personally signed by me/us.
I/We undertake to pay the bank charges associated with this assignment, and I/We authorise you to recover the value thereof in accordance with the prevailing rate of the South African Clearance Bank at the time
of withdrawal.
I/We understand that:
- the debit order that I/we hereby authorise will be processed by a computer;
- the details of each withdrawal will be shown on my/our bank statement or accompanying document; and
- the obligation to ensure that my/our monthly premiums are indeed received by you remains my/our responsibility, notwithstanding the granting of this debit authorisation to you.
I/We undertake to satisfy you/us from time to time that you have withdrawn the necessary amount payable for the monthly premiums for the above membership under this Debit Order Authorization
, and I/We hereby record that your acceptance of this Debit Order Authorization does not in any way place any burden on you to ensure that the monthly debit orders of the amount referred to
hereindoes not take place. This authorization will remain in full force and effect until I/we cancel it by sending you a 30-day written notice by registered mail, but I/we understand that I/we will not be entitled
to any refund of any amount you withdrew while this authorization was in effect, unless I/we can prove that any such amounts were not legally owed to you. I/We will consider your
receipt of this instruction to be receipt of it by my/our bank. Pioneer reserves the right to apply an annual increase tied to the rate of inflation, plus 2%.
How do I join?
- Complete this application form and fax it to 086 230 1166 or mail it to P.O. Box 17216, LYTTELTON, 0140.
- Call 086 10 200 30 or send an e-mail to info@pionierdienste.co.za.
