PERSONAL INFORMATION

Please provide your details below. All fields marked with an asterisk (*) are mandatory.

Section 18A Certificate

If YES, please provide the following details:

Complete this section if you select Debit Order as your payment method.

I/We hereby authorize Street Salvation NPC to draw against my/our account with the bank listed below (or any other bank or branch to which I/we may transfer my/our account) the amount indicated on the 1st or 20th day of each month, commencing on and continuing until termination of our agreement or cancelled by me/us in writing with thirty (30) days’ notice.

I/We understand that withdrawals will be processed through a computerized system provided by South African banks, and details of each withdrawal will appear on my/our bank statement. All withdrawals shall be treated as though personally signed by me/us. This authority may not be ceded or assigned to any third party without my/our prior written consent, and I/we may not delegate any obligations under this agreement without the prior written consent of Street Salvation NPC.

POPIA Consent

All personal information collected and maintained by Street Salvation NPC will be handled in accordance with the Protection of Personal Information Act 4 of 2013 (POPIA). By signing this form, I/we consent to the collection, processing, and disclosure of my/our personal information to relevant third parties where necessary for the purposes of membership and donation processing.

Declaration

I/We confirm that the information provided is accurate and agree to the terms outlined in this form.