In order for RMB Private Bank (RMB PB) to successfully switch your debit orders and/or salary and/or recipients, we will need you to supply us with some detailed information. On the below form, please fill in your details in the given fields and indicate your request by making an X in the appropriate boxes. You can cross out any non-applicable sections for your own security. Once completed, please fax the document to 0860 566 569 or scan and e-mail the document to debitorders@fnb.co.za. If you have any questions, please call us on: 087 736 7001 (Select option 2). Full Identity Cellphone Telephone Address I hereby appoint RMBPB to switch the following on my behalf (Make an X in the appropriate boxes) 1 My Salary 2 My Debit Orders 3 My Recipients From the following account Bank Account Account Type Branch Branch Code To this RMBPB account Account Account Type Branch Branch Code Switch My Salary RMBPB will contact my employer at the number below and instruct them to pay My Salary into my RMBPB account. Please note that all fields are mandatory: Employer My Salary Date Employee of Contact Person Telephone Address Switch My Debit Orders To enable RMBPB to switch your debit orders we need you to complete Annexure 1 for all Cellphone Related Debit Orders and Annexure 2 for all Other Debit Orders. Please note that all fields are mandatory, without the completed information we are unable to process your application. 3. Switch My Recipients To enable RMBPB to switch your Recipients on payments we need you to complete Annexure 3 OR give us your individual recipient printouts by obtaining it from your online banking profile or from your previous bank. Initial Here Page 1 of 5 Version 0 DEBIT ORDER SWITCHING FORM
UNDERTAKINGS, INDEMNITY AND WAIVER By signing this form I understand and agree that: Debit Order and Salary Switching: To carry out my salary switching request RMBPB will contact and instruct my employer to pay my salary into my RMBPB Account and can do all other things necessary, including asking my employer to give RMBPB personal information or any other information related to the salary switching. To carry out my debit order switching request, RMBPB will contact and instruct the persons I pay by debit order to deduct debit orders from my RMBPB Account and can do all other things necessary, including requesting them to provide RMBPB personal information or any other information related to the debit order. To carry out this instruction RMBPB can disclose all the information on this form to my employer or the persons I pay by debit order. Because RMBPB relies on the Service Provider/Employer to carry out this request, RMBPB cannot guarantee the date and time when the debit order/salary will be switched to my RMBPB Account. Important te: Some Service Providers/Employers may not accept instructions from RMBPB. In such an instance I may still be required to switch the debit order/salary myself. I must keep enough money in both my existing and RMBPB Account/s, until I have been notified by RMBPB that the debit orders/salary has been switched. I agree to waive (give up) any claim I may have against RMBPB if a debit order/salary is not switched by the Service Provider/s/Employer on time. Recipient Switching: We can help you load your existing/new Recipients, to enable you to do electronic payments via Online Banking/Cellphone Banking/Telephone Banking/ATM. You will need to allow two business days for the money to reach the beneficiary s account in the event of a payment instruction. In most instances payments to RMBPB Recipients will reflect on their account on the same day and payments to non-rmb Recipients will reflect on their account the following business day. Some recipients (e.g. Municipalities) have special processing requirements and payments may take longer to reflect on their accounts. The beneficiary s account number is not verified against the branch code or the account holder s name by RMBPB, you therefore need to ensure all the details you supply are correct. tice of confirmation of payment to the recipient does not guarantee that the recipient has received the payment or has access to the funds. The cost of sending a fax, email or will be debited to your account. Refer to the RMBPB Pricing brochure on www.rmbprivatebank.com or contact us on 0860 11 22 44 for more information. General: RMBPB will keep me updated of the progress by sending me an or by calling or emailing me at the contact details I provided above. RMBPB will confirm the date that each debit order/salary/beneficiary is switched to my RMBPB Account by sending me an or by calling or emailing me at the contact details I provided above, or by sending me an incontact message. The information I gave RMBPB in this document is correct. I understand that RMBPB cannot verify whether the information is correct. Because of this I cannot hold RMBPB responsible if the information I gave RMBPB was incorrect. I can only cancel this request by giving RMBPB written notice. I hereby indemnify RMBPB and will not hold it liable for any costs, charges, expenses, losses and damages, or third party claims which I may suffer as a result of RMBPB acting in accordance with this request. I agree to waive (give up) any claim I may have against RMBPB arising from RMBPB s performance of this request. Customer Signature Date D D M M Y Y Y Y For office use: Request submitted by (Make an X in the appropriate box) Branch Banking Premier Private Clients Business Commercial RMBPB BANKER/RM CBS Fulfilment Acquisition CONSULTANT NAME AND CONTACT NUMBER Page 2 of 5 Version 0 DEBIT ORDER SWITCHING FORM
ANNEXURE 1 CELLPHONE RELATED DEBIT ORDERS Example 1 Example 2 Service Provider MTN MTN Contract Holder Mr RB Jacobs Mrs G Jacobs Contract Holder ID 7205241236217 7102040046085 Contract DL14451133 AL33404400 Cellphone 082 123 4567 082 338 3913 Date Of Debit Order 25 th M 25 th M Frequency M = Monthly Q =Quarterly A = Annually Last Known Debit Order Amount R 530.00 R250.00 3. 5. 7. 8. 9. 10. Page 3 of 5 Version 0 DEBIT ORDER SWITCHING FORM
ANNEXURE 2 OTHER DEBIT ORDERS Service Provider (Please include Company & the Department) Policy Holder Policy Holder ID Policy Date Of Debit Order Frequency M = Monthly Q =Quarterly A = Annually Last Known Debit Order Amount Example 1 Example 2 RMB Insurance RMB Personal Loan Mr RB Jacobs Mrs I Jacobs 7205241236217 7102040046085 DL14451133 4000000123456 25 th M 30 th M R1,000.00 R250.00 3. 5. 7. 8. 9. 10. Page 4 of 5 Version 0 DEBIT ORDER SWITCHING FORM
ANNEXURE 3 RECIPIENTS Recipients Account Bank Branch Code Account Type 1 = Current 2 = Savings 3 = Transmission 4 = Bond 5 = Credit card My Reference (max 19 characters) Example Mr Peter Smith 90012345677 RMB 250655 1 Peter Recipient Reference (max 19 characters) Rent from Adrian If you wish to send a notice when the amount is paid, please complete the required details: (011) 3712546 0824569851 name@domain.co.za 3. 5. Page 5 of 5 Version 0 DEBIT ORDER SWITCHING FORM