First name(s)
Title
- DRDR
- MRMR
- MRSMRS
- MSMS
- PROFPROF
- REVREV
- SIRSIR
- THE HONTHE HON
I hereby authorise the above applicant to reload funds on my behalf. I acknowledge that the Bank agrees to such an instruction on condition that
the Bank will not be liable for any loss (financial or otherwise), damage or delay, sustained by me as a result of the Bank providing this service
except if the loss (financial or otherwise) damage or delay is directly due to the negligence or default of the Bank’s officers or employees. The Bank
will not be liable for any exchange rate loss, however caused, on conversion of any funds received. Furthermore I confirm that I understand it is my
responsibility to comply with all SARB Exchange Control Rulings.