CITY OF WINDHOEK
Department of Finance and Customer Service
Revenue Management Division
PO Box 59, Windhoek, Namibia
APPLICATION & CANCELLATION FOR DIRECT DEBITING
RESIDENTIAL / NON-RESIDENTIAL
A. I/We herewith instruct my/our bank to make payment as stated below and my/our bank can debit my/our bank account:
1. RESIDENTIAL/ NON-RESIDENTIAL
Debtor’s account number:
Title, First Name and Surname:
Identity number/Passport number:
Contact details: (C) (W)
Postal Address:
2. DIRECT DEBITING OPTION
New Application Cancellation Changing Banking details
Monthly payment Option: 1st 15th
Date of first deduction: / / 20
Day Month Year
Cancellation Date for Direct Debiting: / / 20
Day Month Year
3. BANK DETAILS OF ACCOUNT HOLDER
Full Name of Account Holder:
Postal Address:
Contact details: (C) E-mail:
Bank Name: Branch / BIC Code:
Account Number:
Account type: Current/Cheque Savings acc Transmission acc
Premium payable varies as per account due but may not exceed the Maximum limit of
B. Declaration
I/We hereby declare as follows:
• I/We have the necessary authority to sign this Mandate Authority.
• The information herein provided to City of Windhoek is true, correct and complete. The information shown
above is correct.
• I/We agree to be bound by signing this Mandate Authority.
• By signing this Mandate Authority, I/we agree that any previous Mandate Authorities signed by me/us
relating to Agreement Reference Number: is hereby revoked.
Signed at on this day of 20
(Signature as used for operating on the account) (Signature as used for operating on the account)
Beneficiary / Payment to: Municipal Council of Windhoek
Abbreviation name: WHKMUN
Beneficiary Postal Address: PO Box 59 Windhoek
Payee Statement reference: WHKMUN
This signed Authority and Mandate refers to the contract between me/us and the Municipal Council of Windhoek
“hereinafter referred to as “City of Windhoek” dated (“the Agreement”).
I/We hereby authorize City of Windhoek to issue and deliver payment instructions to their Banker for collection against
my/our above-mentioned account at my/our above-mentioned Bank (or any other bank or branch to which I/we may
transfer my/our account) on condition that the sum of such payment instructions will never exceed my/our obligations
as agreed to in the Agreement and commencing on and continuing until this
Authority and Mandate is terminated by me/us by giving you. notice in writing of not less than 5 (five) ordinary
business days, and sent by prepaid registered post or delivered to your address as indicated above.
The individual payment instructions authorized to be issued, must be issued and delivered monthly.
In the event that the payment day falls on a Sunday, or recognized public holiday in the Republic of Namibia, the
payment day will automatically be the very next ordinary business day. Furthermore, if there are insufficient funds
in my/our account to meet the obligation, you are entitled to re-represent the instruction for payment to my
account for a period of days ( ) (Number in words) days.
Due to the customary early payment of salaries in December, I hereby authorize you to present my December
payment instructions earlier, aligned with my salary payment date. Furthermore, if there are insufficient funds
in my/our account to meet the December obligation, you are entitled to re-present the instruction to my/our
account for payment as soon as sufficient funds are available for a period of
days ( ) (Number in words) days.
I/We understand that the payments hereby authorized will be processed through a computerized system provided
by the Namibian Banks. I/We also understand that details of each payment will be printed on my/our bank
statement. The bank statement must contain a reference number for identification, which must be included in
the said payment instruction and if provided to me/us should enable me/us to identify such transaction as linked
to this payment instruction authorization. This number must be added to this form in Section F before the issuing of
any payment instruction.
C. Mandate
I/We acknowledge that all payment instructions issued by City of Windhoek shall be treated by my/our above-
mentioned Bank as if the instructions have been issued by me/us personally.
D. 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 shall not be entitled to any refund of amounts which City of Windhoek have
collected while this Authority was in force, if such amounts were legally owing to City of Windhoek.
E. 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, but in the absence of such cession or assignment of the Agreement, this Authority and
Mandate cannot be assigned to any third party.
F. Agreement Reference Number
This Agreement reference number is WHKMUN
G. Assisted by
Full Name & Surname Signature Date
