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O Ref 2013/001 SCHOOL NAME NORTHERN ACADEMY FAMILY CODE / LEARNER NUMBER DETAILS - DEBTOR FULL NAME & SURNAME CELL PHONE NUMBER E-MAIL ADDRESS DETAILS - BANK BANK ACCOUNT NAME BRANCH ACCOUNT NUMBER BRANCH NUMBER ACCOUNT TYPE SCHOOL FEES HOSTEL FEES AFTERCARE BUS NAME LEARNER 1 NAME LEARNER 2 NAME LEARNER 3 NAME LEARNER 4 OTHER OTHER OTHER OTHER OTHER OTHER GR GR GR GR OTHER OTHER CHEQUE / SAVINGS / TRANSMISSION TOTAL DEBIT ORDER AMOUNT R This signed Authority and Mandate re.

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