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AVBOB Cashback Insurance
This document is an authorization for AVBOB Mutual Assurance Society to debit amounts from a policyholder's bank account for insurance premiums and loan or debt repayments. It includes the policyholder's contact and banking details in Sections A and B. Sections C through F specify the amounts to be debited monthly for loan repayment, premiums, premium debt, and automatic non-forfeiture repayment. The policyholder signs in Section G to authorize AVBOB to debit the account on dates coinciding with their salary receipt dates.
AVBOB Cashback Insurance
- 1. SECTION A –CONTACT DETAILS SECTION B – BANKING DETAILS 04/2016 1012 Head office use only ID number Policyholder Tel no Cell no Name of employer Fax no Email Payment due date: variable to coincide with my salary receipt date NB: Copy of bank statement must be attached. AVBOB Mutual Assurance Society is an authorised financial services provider DEBIT ORDER AUTHORISATION FOR PREMIUMS AND DEBT REPAYMENTS Postal address Residential address Postal code Postal code POLICY NUMBER Account holder Account number ID number Branch code City/town Name of bank Cell no Branch name Type of account Savings Transmission Cheque AVBOB AVBOB MUTUAL ASSURANCE SOCIETY 368 Madiba Street, Pretoria, 0002 PO Box 1661, Pretoria, 0001 Tel: 0861 28 26 21 Email: info@avbob.co.za
- 2. Amount to bedebited monthly SECTION C – LOAN REPAYMENT AMOUNT Amount to be debited monthly SECTION D – PREMIUM AMOUNT Amount to be debited monthly SECTION F – PREMIUM DEBT AMOUNT Amount to be debited monthly SECTION E – AUTOMATIC NON-FORFEITURE REPAYMENT AMOUNT Sections C, E and F: Send completed document to info@avbob.co.za or fax to 012 303 1383. I hereby authorise AVBOB Mutual Assurance Society to debit my account with the above-mentioned bank for the amounts payable as specified herein. I acknowledge that the payment due date will vary from month to month to coincide with my salary remuneration dates as determined by my employer and request AVBOB Mutual Assurance Society to debit my account on these dates or as close as possible to these dates. Section D: Send completed document to debitorders@avbob.co.za or fax to 0866 789 469. SECTION G – AUTHORISATION SIGNATURE OF ACCOUNT/CARD HOLDER DATE YYYYMMDD R R R R 04/2016 1012