RM_StatsDEBIT ORDER INSTRUCTION FORM Personal Details First Name *Last Name *Mobile Number *Email *Account Details Bank Name *Account Name *Account Number *Branch Code * Payment InstructionsDonation Intention: *LillahZakaatAmount *Date of First Payment *Agreement and ConsentI/We hereby instruct and authorize you to draw against my/our account with the above-mentioned bank (or any other bank or branch to which I/we may transfer my/our account). All such withdrawals from my/our bank account by you shall be treated as though they had been signed by me/us personally. I/We understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks and I also understand that the details of each withdrawal will be printed on my bank statement. I/We agree to pay any bank charges relating to this debit order instruction. This authority may be cancelled by me/us by giving you thirty day’s notice in writing, sent by email to rkajee@raudatul-islah.com, but I/we understand that I/we shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force. Receipt of this instruction by you shall be regarded as receipt thereof by my/our bank (whichever it is or will be).I acceptUpload your Digital SignatureIf you do not have a Digital Signature to upload, kindly click on Save to PDF button below and follow the instructionsIf you are unable to Esign the document, click on Convert to PDF button below, save it to your device, print the document, sign it and email the signed document to rkajee@raudatul-islah.com Convert to PDF Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
