Debit Order Instruction Form


Dear Sirs/Madams,

Please debit my account on the                                   day of every month with an  amount of                                                        payable into the ULA's bank account as follows:    

                                                                                    Account Holder: United Liberty Alliance
                                                                                    Bank                       : ABSA Cheque Account
                                                                                    Branch                  : Caledon 632005
                                                                                    Swift Code          : ABSAZAJJ
                                                                                    Account #           :4097574072

I hereby request and authorise you to draw against my/our account with the abovementioned bank (or any other bank or branch to which I/we may transfer my/our account).  This being the amount necessary to fulfill the monthly obligation in respect of my/our purchases / contract / agreement as indicated on this form. 


All such withdrawals from my/our account by you shall be treated as though they had been signed by me personally. 

I/we the undersigned 'instruct' and authorise ABSA Bank to draw against my/our account.  I /we understand that if bank details have been supplied the withdrawals authorised here will be processed by ABSA Bank.  I/we also understand that details of each withdrawal will be printed on my/our bank statement.  I/we agree to pay any banking charges relating to this debit order instruction.

This authority may be cancelled by means of giving you thirty days' notice in writing, sent by prepaid registered post or email, but I/we understand that we shall not be entitled to any refund of amounts, which you have withdrawn while this authority was in force if such amount were legitimately owed to you.

I/we acknowledge that the party hereby authorises to effect the drawing(s) against my/our account may not cede or assign any of its rights and that I/we may not delegate any of my/our obligations in terms of this contract/authority to any third party without prior written consent of the authorised party.

Signed in                                                                                     on this                                           day of                                                                  



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Supporting sovereign self-determination is not treason. Self-determination is legal according to the South African Constitution as well as International law. The ULA therefore follows a 100% internationally recognized legal process and the South African government will be forced to comply.

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