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DEBIT ORDER Authorization AGREEMENT Entered into between Focus on Health (Pty) Ltd and The Subscriber (Please print clearly) Surname: Initials: HP CSA NR: Tel: Cell: Bank Information: Period at Current

How to fill out debit order authorisation agreement

How to fill out a debit order authorisation agreement:

1. Fill in your personal information: Provide your full name, address, and contact details. This information is necessary for the debit order to be set up properly.
2. Enter your bank account details: Include your bank name, account number, and branch code. This ensures that the funds can be deducted from your account accurately.
3. Specify the payment details: Indicate the amount that will be debited from your account, the frequency of the payments (e.g., once off, monthly, quarterly), and the start date of the debit order.
4. Sign and date the agreement: Read through the terms and conditions of the debit order authorisation agreement carefully. Once you understand and agree to the terms, sign the agreement and provide the date of signing.

Who needs a debit order authorisation agreement?

1. Individuals making regular payments: If you need to make recurring payments for services such as insurance premiums, membership fees, or subscription services, you may need a debit order authorisation agreement.
2. Companies collecting payments: Businesses or organizations that collect payments from customers on a regular basis, such as utility companies, gyms, or telecommunication providers, often require customers to sign a debit order authorisation agreement.
3. Creditors for loan repayments: Lenders may request borrowers to sign a debit order authorisation agreement to ensure timely repayment of loans. This helps streamline the repayment process and reduce the risk of missed or late payments.

Note: It is essential to carefully review the terms and conditions of the debit order authorisation agreement before signing. Make sure you understand the payment terms, cancellation process, and any fees associated with the debit order. If you have any doubts or questions, seek clarification from the relevant parties before signing the agreement.

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