From: (Name of Account Holder) Address:Date: Bank account to be debited: Name of Bank: Name of Branch: Branch Number: Type of Account: Account Number: The sum of R: Assignment: I/We acknowledge that the party hereby authorised to effect the drawing/s against my/our account may not cede or assign any of its rights to a third party without my/our prior consent and that I/we may not delegate any of my/our obligations in terms of this contract/authority to any third party without prior written consent of the authorised party. SIGNATURE OF BANK ACCOUNT HOLDER: Clear SignatureDATE: SIGNED AT: Generate & Email PDF
