+27 11 262 5115 | +27 21 202 7890 +27 12 342 1177
+27 11 646 1984
www.emendy.co.za
www.aie.ac |
[email protected] [email protected] www.designcenter.co.za
[email protected] Agreement & Debit Order Mandate between the
Academic Institute of Excellence (Pty) Ltd “AIE” / Emendy, Greenside Design Center “GDC”
and
Person responsible for account
First Names: _________________________________________________________________________________________________________________
Surname: ____________________________________________________________________________________________________________________
Gender: ____________________________ Date Of Birth:__________________________________ Nationality: _______________________
Id No./ Passport No.: ___________________________________ Home Contact Tel. No.:__________________________________________
Cell No: _______________________________________________ Email Address:______________________________________________________
Residential Address:__________________________________________________________________________________________________________
Student Name & Surname: _________________________________________________________________________________________________
Debit order details
Name of the Account Holder:
Bank
Branch Code:
Account Number:
Type of Account:
Date of First Deduction Debit Order Date:
Number of Instalments Debit Order Amount R
*I understand and agree to the information on this page
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AIE Jhb Campus:
1 Oracle Close | Halfway Gardens | Midrand Emendy Campus: Greenside Design Center:
1043 Pretorius St | Hatfield | Pretoria 118 Greenway, Greenside,Johannesburg
Registration Certificate No 2000/HE07/28 Registration Certificate No 2000/HE07/28
Registration Certificate No 2022/HE07/005
DOF2021/08/17
+27 11 262 5115 | +27 21 202 7890 +27 11 646 1984
+27 11 262 5115 | +27 21 202 7890 www.aie.ac | [email protected] +27 12 342 1177 www.designcenter.co.za
+27 11 646 1984
www.aie.ac | [email protected] www.emendy.co.za [email protected]
www.designcenter.co.za
[email protected]
[email protected]
Abbreviated Name as Registered with the Bank: ACADEMICIN/GDC/EMENDY
This signed Authority and mandate refers to our contract dated (“the agreement”)
I/We hereby authorise you to issue and deliver payment instructions to your 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 20 ordinary working days, and sent by prepaid registered post or delivered to
your address as indicated above.
The individual payment instructions so authorised must be issued and delivered monthly.
In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will
automatically be the preceding ordinary business day.
Payment Instructions due in December may be debited against my account on ___________
I / We understand that the withdrawals hereby authorized will be processed through a computerized system provided by
the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each
transaction will contain a number, which must be included in the said payment instruction and if provided to you should
enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment
instruction.
Mandate
I / We acknowledge that all payment instructions issued by you shall be treated by my/our above-mentioned Bank as if the
instructions have been issued by me/us personally.
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 you have withdrawn while this Authority was in
force if such amounts were legally owing to you.
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 assignment of the Agreement, this Authority and Mandate cannot be
assigned to any third party.
I HEREBY ACCEPT AND AGREE THAT: I have read and understood the Terms & Conditions as set out in the
application form and hereby grant AIE authority to debit my account every month
Signed at ____________________________ on this ______________________ day of ______________________________ 20 ____________
___________________________________________________
(Signature as used for operating on the account)
___________________________________________________ Agreement reference number is ____________
(Assisted by)
AIE Jhb Campus:
1 Oracle Close | Halfway Gardens | Midrand Emendy Campus: Greenside Design Center:
1043 Pretorius St | Hatfield | Pretoria 118 Greenway, Greenside,Johannesburg
Registration Certificate No 2022/HE07/005 Registration Certificate No 2000/HE07/28 Registration Certificate No 2000/HE07/28
DOF2021/08/17
