with ID number

herby nominate

BORNMAN SCHOEMAN INC ATTORNEYS,
3 Sarel Cilliers Steet Bellville, 7530

with Power of Substitution to be my appointed Attorney in name, place and stead to, obtain any records from me, the Client, and/or my creditors and/or credit bureau. I hereby give full power and authority to my lawful Attorney to act on my behalf, in my name, and in my stead to my benefit. To conduct any action as stipulated above and to act as reasonably required in circumstances. I undertake to confirm/validate anything done or allowed in terms of this Special Power of Attorney.

I acknowledge the following:

1. That this is NOT a debt review
2 That a once-off assessment fee will be charged
3 That a Negotiation Fee equal to one monthly instalment, payable in 6 (six) monthly instalments will be charged;
4 That a 10% monthly service fee is payable per instalment paid
5 That instalments must be paid to the following bank account on a monthly/weekly basis:

Bank: First National Bank
Account Name: Bornman Schoeman Inc. Trust
Account Number: 6230 798 1961
Branch Code: 250655
Reference to be used: ID Number

Consent

I hereby give consent to BS Inc Attorneys to make use of the DebiCheck payment system process to facilitate my monthly instalment deduction.

Payment Authorization

(Electronic debit mandate authority in respect of all electronic debits)