Debit Order Mandate

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Section A

This signed Authority and Mandate refers to our contract Agreement I / We declare that the details provided above are correct I have read, understand and accept the Terms and Conditions of Travel Freedom, and acknowledge that the terms and conditions shall not be breached I accept the Administrator shall not be bound by any undertaking or otherwise from any person other than that which is written within this Document I accept that the Administrator reserves the right to amend any incorrect information on the application form and to notify me of these Amendments I hereby provide permission for the agreed monthly debit to be deducted from my bank account on a monthly basis In the event that the payment day falls on a Sunday or recognized South African public holiday, the payment day will automatically be the preceding ordinary business day Furthermore, if there are insufficient funds in my 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 Payment Instructions due in December may be debited against my account on 15 / December / 2021 / understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks I also understand that details of each withdrawal will be printed on my bank statement Such must contain a number, which number must be included in the said payment instruction and if provided to me should enable me to identify the Agreement This number must be added to this form in Section E before the issuing of any payment instruction I further provide consent to be notified by telephone, e - mail and I or facsimile regarding policy renewal, additional product information and special offers

Section B

B. MANDATE 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

Section C

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such cancellation will not cancel the Agreement I / We shall not be entitled to any refund of amounts which you have withdrawn while this Authority was enforce, if such amounts were legally owing to you

Section D

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, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party