DEBIT ORDER AUTHORISATION If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required STRATCOL USER NO: 11115551 STRATCOL USER NAME: 8475 SERVICE RATING STRATCOL ABBREVIATED NAME: SERVRATE (This will be the name appearing on your Bank statement) STRATCOL USER PHYSICAL ADDRESS: 812 10th AVENUE, WONDERBOOM SOUTH, PRETORIA, 0084 REP CODE ACCOUNT HOLDER (DEBTOR) INFORMATION: ID NO. / REGISTRATION NUMBER: * NAME & SURNAME / COMPANY NAME * Address 1 * City * Zip / Post Code * CONTACT DETAILS HOME * CONTACT DETAILS MOBILE * CONTACT DETAILS WORK * IF COMPANY / CC, NAME OF PERSON(S) SIGNING THIS * ACCOUNT HOLDER NAME * BANK * BRANCH / BRANCH CODE * ACCOUNT NUMBER * ACCOUNT TYPE * CURRENTSAVINGSTRANSMISSIONOTHER IF OTHER PLEASE SPECIFY COLLECTION INSTRUCTIONS: COLLECTION INTERVALS * ONCE OFFMONTHLYBOTH IS THIS LIMITED TO FIXED AMOUNTS, OR TO DEBITS DUE IN FUTURE THAT MAY VARY * FIXED ANOUNTSVARIABLE AMOUNTS NOTE: IF VARIABLE, THE AMOUNT(S) HEREUNDER MAY EXCEED ONCE OFF TRANSACTION COLLECTION DATE * AMOUNT * RECURRING TRANSACTIONS - CONTINUE INDEFNATELY UNTILL CANCELLED BY DEBTOR * YESNO 1st COLLECTION DATE AMOUNT * DAY OF MONTH THERAFTER: EXAMPLE 1 TO 31 * ANNUAL ESCALTION: (%) * ESCALATION MONTH - EXAMPLE JANUARY, FEBRUARY, MARCH ETC. * IF NOT INDEFNATELY - NUMBER OF DEDUCTIONS FINAL DATE I / We, the above mentioned and undersigned, hereby authorise StratCol to collect by debit order from the above mentioned bank account, all amounts due in terms hereof and to pay same to the Stratcol User above. (I confirm that I / we are the person(s) with signature authority as registered with my / our bank). SIGNATURE (1) - SPECIFY NAME * SIGNATURE (2) - SPECIFY NAME * DATE SIGNED * Anti-Spam: WHAT IS 10 MINUS 5 = * BY CLICKING SUBMIT BUTTON. YOU AGREE THAT YOU HAVE READ AND ACCEPT THE AGREEMENT OF CONTRACT AND THE DEBIT ORDER AUTHORISATION TO BE IMPLIMENTED AS SPECIFIED BELOW. AGREEMENT I/we hereby authorise STRATCOL to issue and deliver payment instructions to my / our banker for collection against my/our abovementioned account at my/our abovementioned bank. The individual payment instructions so authorised to be issued, must be issued and delivered according to the abovementioned interval on the date when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the Agreement. The payment instructions so authorised to be issued, must carry a number, which number must be included in the said payment instruction and if provided to me / us should enable me / us to identify the agreement on my / our bank statement. The said number should be added to this form on page 1 under client reference number, before the issuing of any payment instruction and communicated to me / us directly after having been completed by me / us. I/we agree that the first payment instruction will be issued and delivered as per collection instruction. If however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I / We agree that the payment instruction may be debited against my / our account on the following or previous business day. NAEDO Allows for tracking of dates to match with flow of Credit at no additional cost to myself / ourselves. I / We authorise the originator to make use of the tracking facility as provided for in the EDO system at no additional cost to myself / ourselves. Subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the Agreement have been paid or until this authority is cancelled by me / us by giving the Stratcol User notice in writing of not less than the interval (as indicated on the Authorisation) and sent by prepaid registered post or delivered to his / her / its address indicated above. MANDATE I / we acknowledge that all payment instructions issued by the Stratcol User shall be treated by my / our abovementioned bank as if the instructions had 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 also understand that I / we cannot reclaim amounts, which have been withdrawn from my / our account (paid) in terms of this authority and mandate if such amounts were legally owing to the Stratcol User. 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.