Application For Non-Profit Organisation Funding

Application For Non-Profit Organisation Funding - 2011 Page 14

13.5 Schedule 5: Bas Form

System User Only

BAS Ref No.

PROVINCIAL ADMINSTRATION WESTERN CAPE

Captured by

Date Captured

BAS ENTITY MAINTENANCE BANK DETAILS

Authorised By

Date Authorised

Bank Details

Name

Address

Contact Person (s)

Contact No.

I/We hereby request and authorise you to pay any amounts which any accrue to me/us to the credit of my/our account with the

mentioned bank.

I/We understand that the credit transfers hereby authorised will be processed by computer through a system know as the "ACB

ELECTRONIC BANK TRANSFER SERVICE", and I/We also understand that no additional advice of payment will be provided by my/our bank,

but details of each payment will be provided by my/our bank, but details of each payment will be printed on my/our ban statement or any

accompanying voucher. (This does not apply where it is not customary for banks to furnish statements)

I/We understand that a payment advice will be supplied by the Department in the normal way, and that it will indicate the date on which

funds will be available in my/our account. This authority may be cancelled by me/us by giving thirty days notice by prepaid registered post

Initials and Surname

Authorised Signature

Date dd/mm/yyyy

Name of Bank

Name of Branch

Branch Code

Account Number

Type of Account

Current Account

Savings Account

Transmission Account

Other (Specify)

FOR OFFICE USE ONLY

DATE STAMP

APPROVED BY HEAD OFFICE

OF BANK

Print Name

BANK

ACCOUNT

Signature

PARTICULARS

CERTIFIED AS

CORRECT

Date

Business Plan for Non-Profit Organisation Funding

Page 14

Application For Non-Profit Organisation Funding - 2011 Page 14

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