Paysoft Impact
Funda Nenja monthly giving program
Debit order facility
Authorising person
First name
*
Last name
*
Email address
*
Contact number
*
I'm signing on behalf of an organisation
Company name
*
Company registration number
(Optional)
Company contact number
(Optional)
I want a tax certificate
Identification or passport number
*
Identification type
*
Unknown
South African ID book or Card
Passport
Country of issue
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas (the)
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory (the)
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands (the)
Central African Republic (the)
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands (the)
Colombia
Comoros (the)
Congo (the Democratic Republic of the)
Congo (the)
Cook Islands (the)
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic (the)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands (the) [Malvinas]
Faroe Islands (the)
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories (the)
Gabon
Gambia (the)
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (the)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (the Democratic People's Republic of)
Korea (the Republic of)
Kuwait
Kyrgyzstan
Lao People's Democratic Republic (the)
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands (the)
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (the Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands (the)
New Caledonia
New Zealand
Nicaragua
Niger (the)
Nigeria
Niue
Norfolk Island
Northern Mariana Islands (the)
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines (the)
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Republic of North Macedonia
Romania
Russian Federation (the)
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan (the)
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands (the)
Tuvalu
Uganda
Ukraine
United Arab Emirates (the)
United Kingdom of Great Britain and Northern Ireland (the)
United States Minor Outlying Islands (the)
United States of America (the)
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bolivarian Republic of)
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Tax reference number
(Optional)
Street name
*
Suburb
*
Town/City
*
Province/State
*
Postal code
*
Authorising company
Company name
*
Registration number
*
Contact number
*
Banking details
Account number
*
Account holder
*
Bank name
*
Absa
Access Bank
African Bank
Bidvest Bank
Capitec
FNB - FIRSTRAND BANK
Nedbank
Standard Bank
FNB - FIRSTRAND BANK Lesotho
FNB - FIRSTRAND BANK Namibia
MTN Banking
Postbank (SAPO)
Standard Bank Lesotho
Standard Bank Namibia
UBank (was Teba Bank)
Discovery Bank
Investec Bank
Old Mutual Bank
Standard Chartered
Tymebank
SASFIN Bank Limited
Mercantile Bank
Bank Zero Mutual Bank
Account type
*
Current (Cheque)
Savings
Transmission
Agreement
Start date
*
Duration
*
Indefinite
6 Installments
12 Installments
18 Installments
24 Installments
36 Installments
Custom
Debit day
*
1st
15th
Contract amount
*
100.00
200.00
400.00
Custom amount
Custom amount
*
Set an annual increase on agreement anniversary
Annual increase %
No Increase
2.5%
5%
7.5%
10%
12.5%
Additional info
Legal agreement
Abbreviated short name as registered with the acquiring bank: FUNDANENJA Refer to our contract reference number ("the Contract Reference Number"). I/We hereby authorise Funda Nenja to issue and deliver payment instructions to your banker for collection against my/our abovementioned account at my/our abovementioned 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. I/we agree that the first payment instruction will be issued and delivered on the "Start Date" and thereafter regularly on the "Debit Day" of each month. 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 canceled 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. Mandate I/we acknowledge that all payment instructions issued by you shall be treated by my/our abovementioned bank as if the instructions had been issued by me/us personally. 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. 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.
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