Membership Form Multi

Product Number

Product Cost

Become a Sakeliga member

Choose Membership Option

Personal Details

Activate Membership

Is your business joining or are you joining as an individual?

Name of business

Sector

Registration Number

Become a Sakeliga Member

Personal Information

We need your personal information to register you as a member and to contact you about membership.

ID Number

Sex

Language Preference

Activate Membership

Become a Sakeliga Member

Choose a payment method and authorise payment

Choose a payment method

Debit order authorisation

I / we hereby request and authorize you or your authorized agent to debit the required amount for the monthly/yearly premium in respect of membership against my / our account at the above bank (or any other bank / branch to which I / we may have my / our account transfer). 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 authorize you to recover its value in accordance with the prevailing rate of the South African Clearance Bank at the time of withdrawal. I / we understand that: 1. The debit order hereby authorized by a computer will be processed. Details of each withdrawal will be shown on my / our bank statement or accompanying voucher. 3. The obligation to ensure that my / our monthly premiums are received by you remains my / our responsibility, notwithstanding the grant to you of this debit order authorization. I / we undertake to ascertain from time to time me / us that the necessary amount payable for the monthly premiums in respect of the above membership has been withdrawn by you in terms of this debit order authorization, and I / we hereby note that your acceptance of this debit order authorization does not in any way place any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 here do take place. This authorization will remain in full force and effect until it is canceled by me / us by sending you 30 days written notice by registered mail, but I / we understand that I / we do not accept any refund of any amount you have withdrawn while this authorization was in force will not be entitled unless I / we can prove that any such amounts were not legally due to you. Receipt of this assignment by you will be deemed to have been received by me / our bank.

Title

Initials

Name and Surname

Email Address

Banking Details

Account Holder

Account Number

Bank

Account Type

Branch Number

Day of debit order

Thus completed and signed

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Membership Form Multi

Become a Sakeliga member

Become a Sakeliga Member

Become a Sakeliga Member

Banking Details

Skakels

Nuusbrief