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Ame (Name of Student): Date: To: Name of Bank: Branch: BO s Reference Number (Student BC or IC): Payment Limit: (Maximum amount to be deducted per Expiry Date of this Authorisation: transaction) (a) I/We hereby instruct you to process the BO's instructions to debit my/our account. (b) You are entitled to reject the BO's debit instruction if my/our account does not have sufficient funds and charge me/us a fee for this. You may also at your discretion allow the debit even if this results i.

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