Jozi Experience Tourism & Transportation cc
27 10
th Avenue, Orange Grove, Johannesburg, South Africa. 2192
P. O. Box 184, Westhoven, 2142
Telephone number: +27 11 022 8397  Fax number +27 86 504 5815
info@joziexperience.co.za
Reg No. 2009/105106/23

 

 

 

 

 

 

 

 

 

 

Customer Sign Up Form

Customer Details

 

 

Date of birth:

 

ID/Passport No:

 

Phone:

 

Current address:

 

City:

 

Province:

 

Code:

 

Email address:

 

Postal address:

 

City:

 

Province:

 

Code:

 

Telephone number:

 

Fax number:

 

Mobile:

 

 

 

 

 

 

 

Account reference will be referred to as your telephone number.

 

 

 

 

 

 

 

 

 

 

 

 

Employment Information

Current employer:

 

Employer address::

 

How long?

 

HR Contact Number:

 

Email:

 

Fax:

 

City:

 

Province:

 

Code:

 

Position:

 

Hourly Paid:

 

           Salary:

 

Annual income:

 

Tax Number:

 

 

 

 

 

 

 

 

Name of a relative not residing with you:

 

Address:

 

Phone:

 

City:

 

Province:

 

Code:

 

Relationship:

 

 

 

 

 

 

 

LOAN INFORMATION

Please Click in the circle next to the loan you are applying for :

 

 

 

 

 

 

 

 

 

 

 

From 10% to 30%

Business

 

Personal

 

Car

 

R30,000  R1500 x 24 months

 

 

 

 

 

 

 

 

R50,000   R2500 x 24 months

 

 

 

 

 

 

 

 

R80,000  R3200 x 30  months

 

 

 

 

 

 

 

 

Own Amount

 

Reason for Loan

 

 

 

 

 

 

 

 

 

 

Unique Number: ( Office Use Only ) :

 

 

 

 

 

 

 

 

 

 

 

 

BILLING DELIVERY METHOD

 

 

 

 

 

 

 

 

 

 

EMAIL ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

PAYMENT DETAILS

 

 

 

 

 

 

 

 

 

 

A. Authority

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of account holder 

 

 

Address

 

 

Bank

 

 

Branch and Code

 

 

Account Number

 

 

Type of Account

 

 

 

 

 

 

 

 

 

 

 

Current (cheque)    

 

 

 

 

 

 

 

 Savings         

 

 

 

 

 

 

 

Transmission  

 

 

 

 

 

Amount

 

 

 

 

 

Debit Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To Jozi Experience Tourism & Transportation cc, First National Bank, Acc No. 62303466818, Business Cheque Account, Branch Code 250655, Branch Name Braamfontein.

27 10th Avenue, Orange Grove, Johannesburg, Gauteng, South Africa.

This signed Authority and Mandate refers to our contract dated                                                         (“the Agreement”).

I/We hereby authorise you to issue and deliver payment instructions to your Banker for collection against my/our above-mentioned 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                                                         and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing of not less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address as indicated above.

The individual payment instructions so authorised to be issued must be issued and delivered as   monthly.

In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the very next ordinary business day. Furthermore, if there are insufficient funds in my 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.1

Payment instructions due in December may be debited against my account on                                                          .

I/We understand that the withdrawals hereby authorised will be processed through a computerised system provided by the South African Banks. I also understand that details of each withdrawal will be printed on my Bank statement.

Such must contain a number, which must be included in the said payment instruction and if provided to me should

Enable me to identify the Agreement. This number must be added to this form in Section E before the issuing of any payment instruction.

B. Mandate

I/We acknowledge that all payment instructions issued by you shall be treated by my/our above-mentioned Bank as if the instructions have been issued by me/us personally.

I am aware of a non-refundable fee of R99 is charged for this application which is deducted from my account to authenticate this application process and a unique code is sent to my Bank Statement  for authentication.

Non Refundable Authentication Fee Option.

Debit Order.    ( Amount R99,  Account Number                                                                      . Account Type                                  .

Branch Code                                    . Bank Name                                                      Debit Date                                      .

Cash Payment( Amount R99, Reference is your ID Number, To Jozi Experience Tourism & Transportation cc, First National Bank, Acc No. 62303466818, Business Cheque Account, Branch Code 250655, Branch Name Braamfontein.) Submit this form and the deposit slip to speed your application process.

 

 C. Cancellation

I/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. 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.

D. Assignment

I/We acknowledge that this Authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.

Signed at                                                           on this                                                            day of                                                           .

 

                                                                                                                  .
(Signature as used for operating on the account)

 

                                                                                                               .
                  (Assisted By)

 

E. Agreement Reference Number

This Agreement reference number is your ID number :

 

 PLEASE FILL THIS FORM ONLINE, PRINT AND SIGN THEN FAX IT THROUGH TO
 086 504 5815 or ( info@joziexperience.co.za )
Along with Certified copy of ID, 3 Months Bank Statements & Proof of Residence