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SACU Debit order form
MEMBER REGISTRATION FORM
Please debit my account in the amount of R (please select from this menu:)
R83 Full SACU membership and representation
R75 Individual membership
55 Partial membership
Please make a selection.
On the 1st day of each month as from
(date) as membership subscription to SACU.
*Select amount linked to membership chosen. See below:
Full SACU membership and representation – R83
Individual membership: (Partial benefit plus CCMA representation after being a member for 6 months) – R75
Partial membership: (Telephonic advice and Funeral Cover for you and your immediate family) – R55
Bank Debit Order Information
Select a title
Work Tel. No:
Debit order on:
• I/we agree that if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account; I/We agree to pay any charges related to unpaid/returned items.
• I / We acknowledge that all payment instructions issued by you shall be treated by my/our above mentioned bank as if the instructions had been issued by me/us personally.
• I / We agree that although this Authority and Mandate may be cancelled by me /us, such cancellation will not cancel the Agreement. I / We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
• I/We hereby give authority for the monthly deduction of my membership contribution to SACU (South African Communications Union) be deducted from the above account by Optivest Health Services (Pty) Ltd using the SagePay system.
• I / We acknowledge that this Authority may be ceded to or assigned to a third party if the agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.
Account Holder's Signature
SOUTH AFRICAN COMMUNICATION UNION (SACU)
Tel: 086 100 7228 Fax: 021 914 5883 www.saku.co.za