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Insure Safe Advisors

Debit Form

Debit Form

Insure Safe Advisors

Debit Order Authority


Bank Details


Declaration

I/We hereby request and authorise ONE Financial Services Holdings (Pty) Ltd or it’s nominee to draw against the above account with the above mentioned bank (or any other bank/branch to which I/we may transfer my/our account) the amount necessary for payment of the monthly / annual premium and fee due in respect of the above mentioned insurance. All such withdrawals from the above bank account by you shall be treated as though they had been signed by me/us personally.


I/We understand that:
1. Details of each withdrawal will be reflected on the bank statement of the above account
with a prefix of MFRF ONE, and
2. The obligation to ensure that the monthly premiums are received by the insurer remains
with the insured despite the granting to the insurer of this debit order authorisation, and
3. Should the selected direct debit strike date fall on a weekend or public holiday the
deduction will be done on the next business day, and
4. The amount deducted may differ from month to month due to changes I/we make to
my/our policy.


I/We undertake to satisfy myself/ourselves from time to time that the amount necessary for payment of the annual / monthly premiums due in respect of the above mentioned insurance are duly drawn by the insurer in terms of this debit order authority, and I/we record that your acceptance of this debit order authority in no way places any onus on you to ensure that the monthly / annual withdrawals of the amount referred to herein are made. This authority shall continue in full force and effect until cancelled by the insured by giving 30 days written notice. I/we understand that I/we shall not be entitled to any refund of any amount which the insurer has withdrawn while this authority was in force unless, I/we can prove that any such amounts were not legally owing to you.
I/we undertake that should my/our debit order details change, I/we will notify ONE Financial Services Holdings (Pty) Ltd or your Insure Safe Advisors CC in writing or re-submit this authority with the new debit order details.


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