AGREEMENT TO PAY SAIAT MEMBERSHIP FEES IN INSTALMENTS

AGREEMENT TO PAY SAIAT MEMBERSHIP FEES IN INSTALMENTS
1. PERSONAL INFORMATION

PLEASE TYPE IN CAPITAL LETTERS
1.1 Surname:*
1.2 Full names:*
1.3 SAIAT Membership Number:*
1.4 Invoice Number:*
2. CONTACT DETAILS
2.1 Residential Address:*

Street Address

Street Address Line 2

CityProvince

Postal Code
2.2 Postal Address:*

Postal Address

Postal Address Line 2

CityProvince

Postal Code
2.3 Email Address:*
2.4 Mobile Telephone Number:*

Area CodePhone Number
3. INSTALMENT DETAILS
Total amount due:*
Number of instalments:*
Instalment amount*
Day of month for instalment to be done:*
4. INSTALMENT AGREEMENT
4.1 SAIAT is implementing a DebiCheck system as of 15 September 2023 for intalments. Please ensure that you accept the DebiCheck notification once received.

4.2 Any missed instalment will render this agreement void and the full balance will become payable immediately.
5. YOUR BANKING DETAILS
Account Holder:*
Account Holder ID / Company Registration Number:*
Account Type:*
Account Number:*
Branch Code:*
Account Holder Signature/s*
Date*

DayMonthYear
Should be Empty: