Name of Scheme: VETERANS AID FUND

Details of Main Member

Title
MrMrsMs

Surname

Full Names

ID Number

Cellphone Number

Home Town

Province
—Please choose an option—Eastern CapeFree StateGautengKwaZulu- NatalLimpopoMpumalangaNorthern CapeNorth WestWestern Cape

Email Address

Details of nominated beneficiary

Name

Surname

ID Number/Date of Birth

DEBIT ORDER AUTHORISATION

Name of Bank

Branch Code

Account holder - If not in your name,
Account holder's tel. no. (must contact to confirm)

Account number

Type of account
CurrentSavingsTransmission

Amount

Date of deduction
1st5th10th15th20th25thLast day of the month

Deductions
MonthlyOnceYearly

Please note that your authority and mandate will be confirmed by the recording before any debit order is processed against your account. You hereby authorise Phakama debit your account on behalf of Virtucall (Pty) Ltd representing the Veterans Aid Fund (VAF). Your debit order will be collected on the date as requested. If the debit order collection is unsuccessful for any reason, then two debit orders will run against your account on the month following the unsuccessful collection. The debit order mandate will expire if the second debit order collection attempt is unsuccessful. In the event where the collection date occurs on a Sunday or recognised public holiday, the debit order will automatically run on the next business day. You may cancel this mandate by providing a 30 day's written notice, although this will not cancel this agreement immediately. You will not be entitled to any reimbursement of any funds collected while this Authority is in force. This agreement may only be transfered to a third party if the mandate is also transfered to the third party. You accept and agree that this instruction for payment from your account resulting from this mandate is recognised as an instruction for payment given by you. Your bank statement will refect as follows: VETERANE. Do you understand this mandate? Please confirm if you understand this mandate: (Member must confirm to complete the form)