Confirmation

Et
hekwini Revenue
Managem
ent
Florence Mkhize Building
251
Anton Lembede
Street
Durban
4001
Tel: 031
311 1363/67
Fax: 031
311 1116
E

Mail:
revline@durban.gov.za
Website: http://www.durban.gov.za
NOTIFICATION OF CHANGE
DIRECT DEBIT DETAILS
PARTICULARS OF
CUSTOMER
METRO BILL ACCOUNT REFERENCE:
_________________________________________________________________
_
SURNAME & INITIALS:
_________________________________________________________________
_
ADDRESS:
______
___________________________________________________________
_
____________________________________________ CODE: _______________
ID NO:
_________________________________________________________________
_
TELEPHONE (B):
___________________________
____ TELEPHONE (H): ___________________________________________
_
I hereby notify
Et
hekwini Municipality of the following changes to my Debit Order:
(Indicate what changes you want to make by ticking the appropriate box)
Increase Direct
Debit Limit, from R __________
___
to R
____________
Decrease Direct Debit Limit, from R _________
___
to R ____________
Change of Banking Details as indicated below
Cancel Direct debit Order wit
h effect from
______________________________
20
1
_
BANK ACCOUNT DETAILS
:
NAME OF BANK:
____________________
BANK ACCOUNT NO:
_________________________ BRANCH CODE _________
_
ACCOUNT TYPE:
(X the appropriate box)
NAME & INITIALS OF ACC
OUNT HOLDER
:
_________________________________________________________________
_
PLEASE RETURN THIS FORM
TOGETHER
WITH A
BANK STATEMENT
________________________
____________________________
____
_________________________
_
ACCOUN
T HOLDER SIGNATURE
or
REPRESENTATIVE
SIGNATURE
____________________________
DATE
CONDITIONS
I understand and accept the following conditions of authorization:
1.
Should the above limit be insufficient to settle my bill, I undertake to pay the diffe
rence in cash or via electronic transfer.
2.
I undertake to maintain the above limit at a realistic level at all times.
3.
The Council may cancel the debit order should my bank disallow a debit against my account on two occasions due to insufficien
t funds, or an
y other
reason.
4.
This authorization will remain in operation until revoked by me, by giving 30 days prior written notice to this effect or due
to transfer or termination of
services, or changes in bank details or for any other reason.
5.
If my bank rejects an
y debit against my account for lack of funds or any other reason, I undertake to pay the Council a penalty in respect of each
such
rejection, which amount will be added to my Metro bill, and the amount of such penalty may be varied from time to time in acc
ordance with the Citys by

laws
and tariffs
. A disconnection order will be issued without notice if there is a rejection of the debit order.
6.
I authorise the Council to adjust the above limit automatically whenever there is a tariff increase with a percenta
ge equal to such an adjustment, or if the
limit is insufficient to settle the bill.
7.
Funds should be available at least 24 hours before direct debit due date.
8.
No written notification will be given if the bank returns a debit order. I undertake to contact th
is office immediately should there be a rejection reflected
on my bill.
9.
ASSIGNMENT:
I / We acknowledge that the party hereby authorized to effect the drawing(s) against my/our account may not cede or assign an
y of its rights to any third
party without my
/our prior written consent and that I/We may not delegate any of my/our obligations in terms of this to any third party.
PLEASE COMPLETE IN BLOCK LETTERS
CHEQUE
SAVINGS
TRANSMISSION

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