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Personal Information

Business Information

Address

Banking Details

ABSA Bank Restore Trust
Account Number 4088 069 276
Branch Code 632005
Reference
• Personal LS Initial LastName (e.g. LS R Boucher)
• Business LS Business Name (e.g. LS Vodacom 4U)
I hereby "instruct and" authorise THE RESTORE TRUST Breath of Life, to draw against my account with the above mentioned bank (or any other bank or branch which I may transfer my account) the amount necessary (as stipulated above) for payment in respect of the above mentioned agreement and continuing until termination of our agreement or until cancelled by me in writing. All such withdrawals from my account by you shall be treated as thought I had signed the personally. I understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. I may cancel this authority by giving you thirty (30) days notice in writing, sent by registered mail, but I understand that I shall not be entitled to any refund of amounts which you have withdrawn while this authority was enforced if such amounts were legally owing to you. Receipt of this instruction by you shall be regarded as receipt thereof by my bank (whichever it is or will be).

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