flower JCMI - Centre for the Homeless & Needy flower
 


Registration No.: 028-771-NPO

Tel: + 27 11 855-9886 Fax: + 27 11 29 52454

P.O. Box 3630 - Lenasia South - Ext. 4 1829

E-Mail: jcmi@jcmi.org.za. Web: www.jcmi.org.za

PERSONAL DETAILS:

[MARK WITH AN X WERE APPLICABLE]

PROF.

 

DR.

 

REV.

 

MR.

 

Mrs.

 

MISS

 

APOSTLE

 

PASTOR

 

 

FULL NAME/S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SURNAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POSTAL ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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TEL. DETAILS (STARTING WITH AREA CODE

HOME WORK

 

 

 

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CELL

 

 

 

 

 

 

 

 

 

 

 

 

E-MAIL: ______________________________________________________________

 

MY AGREEMENT FOR REGULAR FINANCIAL SUPPORT

 

PLEASE CROSS WHAT IS APPICABLE:

This is my first debit order for Jesus Christ Ministries International. This instruction replaces my present debit order instruction.

 

Bank Details:

 

NAME OF ACCOUNTHOLDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF BANK

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BRANCH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACCOUNT NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BRANCH NUMBER (SIX DIGIT CODE)

 

 

 

 

 

 

 

 

TYPE OF ACCOUNT:

 

SAVINGS TRANSMISSION CURRENT/CHEQUE

 

 

AMOUNT: R__________________________ IN WORDS ________________________________________________________________

 

I hereby request and authorize JCMI to draw against my account with the above-mentioned bank the above mentioned amount on the _______ day of every month starting on (date) __________________, ________. If the date of deduction falls on a weekend or public holiday, this amount will be deducted on the first working day thereafter. All such withdrawals from my bank account by JCMI shall be treated as though I had signed them personally. Should this debit order not reach JCMI in time for processing on the above-mentioned date, I hereby authorize JCMI to collect outstanding payments in the following month in which the debit order comes into operation. I understand that the withdrawals hereby authorized will be processed by a computer system known as the ACB/BDB Magnetic Tape Service, and I also understand that details of each withdrawal will be printed on my bank statement. I agree to pay, the bank charges relating to this debit order instruction. This authority may be cancelled by me giving JCMI thirty days notice in writing or by e-mail. I understand that I shall not be entitled to any refund of amounts which JCMI has withdrawn while this authority was in place.

Assignment:

I/We acknowledge that the party hereby authorized to effect the drawing(s) against my/our account may not cede or assign any of its rights to any third party without my/our prior written 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 authorized party.

Credit Account details: Name of Account: Jesus Christ Ministries International

Name of Bank: NEDBANK LTD Branch Name: Trade Route Mall Branch Code: 194037 Bank Account No: 1940 105 285

 

 

 

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SIGNATURE OF ACCOUNT HOLDER DATE