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BBT Africa 84 Tennyson Drive, Lombardy East, Johannesburg P.O. BOX 662, BRUMA, 2026 Tel: 011 2640631 Website : www.bbtafrica.co.za PERSONAL DETAILS Title Identity No. CONTACT DETAILS Home E-mail address : POSTAL ADDRESS RESIDENTIAL ADDRESS First Name Last Name Date of Birth Work / /
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Full cash payments of R... for a period of . months / years Monthly D/O of R50 Monthly D/O of R100 Monthly D/O of R150 Monthly Debit Order of R BANKING DETAILS Name of Bank .. Branch Code / Name .. Account Type .. Date to be deducted .//..
I, the undersigned, do hereby authorize ISKCON to debit my account as indicated above. Should I wish to cancel, I will inform ISKCON accordingly
Signature . FOR OFFICIAL USE ONLY ISKCON Representative Palika Devi Dasi Email Address anandatirthadas@gmail.com Donor Number Comments:
Date
//.
0845556111 0865195614