Debit Order Instruction Form |
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Please fill in your details, then print and fax this page to: +27
11 834- 2475 / 086 684 1886 / ali@jmco.org.za
I the undersigned, hereby authorise Johannesburg Muslim Charitable Organisation
to withdraw the undermentioned amount from my account.
| DEBTOR PARTICULARS |
| Name of Debtor: |
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| Address: |
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| Code: |
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| Donation for: |
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Other Details: |
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BANK PARTICULARS |
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| Amount (Rands): |
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Signature: |
____________________________
Signature of account holder |
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