Maritzburg College Foundation - funding appeal Prospectus | Page 9

Maritzburg College Foundation: Donor Pledge Form
Personal Details of Donor
Initials

First Name

Last Name

Company name
ID Number / Company Reg No

COLLEGE OLD BOY

Y

N

FINAL YEAR AT COLLEGE

Postal Address
Postal
Code
Telephone (H)

Telephone (W)

Cell

Email

Fax

Donation / Commitment

(All donations / bequests / commitments are payable over a maximum period of 60months from date of commitment)

Preferred area of support: Please indicate preferred programme you would wish to support
Alan Paton Memorial Scholarship Fund

R36 000* investment per annum over a period of 5years (*annual value maybe revised periodically)

Heritage Capital Fund

Value: R

Jimeloyo Fund

Bronze (R10 000)

Silver (R20 000)

Gold (R40 000)

Diamond (R80 000)

Platinum (R150 000)

36

60 months

Prestige (R500 000+)

specify amount R__________________-________

Appeal
Payable as follows:

-

Once off

Debit order

over

12

24

48

Arranged Payment Terms

Please specify payment terms:
Further conditions of pledge:
I hereby consent that my name be added to the published donors list:

Y

N

Bank Details of Donor and Collection Instruction
Name of Account
Account Type

Current

Savings

Transmission

Branch code

Bank Name

Account Number

Deduction day in the month

Debit order to commence on:

D

D

/

M

M

/

2

0

Y

1

15

28

Y

Terms and Conditions of Collection
1. I hereby declare that the monthly payment constitutes a donation to the Maritzburg College Foundation.
2. I hereby undertake to abide by the arranged payment terms as listed above or hereby authorise that the calculated monthly amount be debited from the nominated account
4. This instruction remains operative until the full amount pledged to the College Foundation has been collected or until I give 30 (thirty) days written notice of cancellation
5. I undertake to ensure that there will always be sufficient funds available in the account that is to be debited.
6. The Maritzburg College Foundation will not be held responsible or liable for any damages, costs or expenses arising from their lawful execution of this instruction.
Date:

D

D

Official use

/

M

M

/

2

Contract no:

0

Y

Y

Signature of Donor: _________________________________
Date Processed:

D

D

/

M

M

Banking Details: Maritzburg College Foundation; Nedbank Current Account; branch code: 116535; Acc# 1004849451

/

2

0

Y

Y