Debit Order Mandate

Debit Order Mandate

I hereby declare giving authority to debit the subsequent account weekly for the bookings completed through CareChamp for the 7 days prior to debit date. The weekly debit amounts might vary slightly according to bookings made - and always be in line with Invoices issued on a weekly basis. Should there be any credits to be made, they will be applied in the subsequent week. CareChamp uses Netcash to process debits. Any related fees are being absorbed by CareChamp.
Given By (Name of Bank Account Holder)*

First NameLast Name
Name of Bank*
Bank Account Number*
(Not Debit or Credit Card number, but actual bank account number pls)
Type of Account*

Current / ChequeSavingsTransmission
Branch Number
Name of the Care Recipient that CareChamp is looking after:*
AMOUNT: this will vary depending on services consumed and invoiced for on a weekly basis.
To (Name of Beneficiary): CARE CHAMP
Abbreviated Shortname to be used: CARE CHAMP
Refer to contract reference: CareChamp_{typeA12} (“the Contract Reference”)
A. TERMS

Refer to the contract in place with CareChamp Homecare (Pty) Ltd for rendering Caregiving / Home Nursing Services.
I/We hereby authorise Netcash (Pty) Ltd to issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my/our above mentioned bank on condition that the sum of such payment instructions will not differ from my/our obligations as agreed to in the Contract Reference Number.
The individual payment instructions so authorised must be issued and delivered on the date when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not differ as agreed to in terms of the Agreement.
The payment instructions so authorised to be issued must carry the Contract Reference [CareChamp_client_name], included in the said payment instructions, and must be provided to identify the specific contract.
I /we agree that the first payment instruction will be issued and delivered on the first Friday after signing the Mandate and thereafter regularly every Friday for the week passed.
If however, the date of the payment instruction falls on a non-processing day (weekend or public holiday) I agree that the payment instruction may be debited against my account on the following business day; or
Subsequent payment instructions will continue to be delivered in terms of this authority until the obligations in terms of the Agreement have been paid or until this authority is cancelled by me/us by giving you notice in writing of not less than the interval (as indicated in the previous clause) and sent by prepaid registered post or delivered to your address indicated above.

B. MANDATE

I/we acknowledge that all payment instructions issued by you will be treated by my/our abovementioned bank as if the instructions had been issued by me/ us personally.

C. 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 also understand that I/we cannot reclaim amounts, which have been withdrawn from my/our account (paid) in terms of this authority and mandate if such amounts were legally owing to you.

D. 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.
Signed at Place* on Date* .
Assisted by: Lauren Jansen

Capacity: Care Manager

FOR OFFICE USE
Signature (as used for operating on the account)*

Clear
Should be Empty: