EMERGIVAC is a product of The Activation Agency (Pty), an authorized financial services provider FSP No. 44785 Ltd. Block F, Acacia Building, Hurlingham Office Park, Sandton, 2196.
This product and its benefits are only valid within the borders of South Africa. The long-term insurance benefits of the EMERGIVAC Plan are underwritten by are underwritten by Clientèle Life Assurance Company Limited. A licensed life insurer and authorised FSP. 15268. Company Registration No. 1973/016606/06.
The Emergency Services and Non-Insured Benefits are administered by The Activation Agency (Pty) Ltd. FSP:44785, through their network of Service Providers and Partners. By applying for and submitting your information you agree to the Clientèle Group processing and retaining your personal information in line with their privacy policy which is available at www.clientele.co.za
This signed Authority and Mandate refers to our contract as dated as on signature hereof ("the Agreement"). I / We hereby authorise you to issue and deliver payment.
I /We, the undersigned, hereby authorise you to issue and deliver payment instructions to the bank for collection against my / our abovementioned account at my / our above mentioned bank (or any other bank or branch to which I / We may transfer my / our account) on condition that the sum of such payment instructions will never exceed my / our obligations as agreed to in the Agreement, and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me / us by giving you notice in writing of no less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address indicated above.
The individual payment instructions so authorised to be issued must be issued and delivered as follows:
1) On the preferred debit date of each and every month commencing on:
2) In the event that the payment day falls on a Saturday, Sunday or recognized South African public holiday, the payment day will automatically be the very next ordinary business day.
Further, 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 understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement.
Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction.
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.
