The Manager,

________________________________________________________________________ (Name of bank)

I, (Name of Contributor)________________________________________________ of the

Address: _______________________________________________________________

________________________________________________________________________

Postal Code: _________ Tel: __________________(H) ______________________ (W)

________________________________________________________________________

Bank Account Details

Name of the Bank: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

Bank Account No: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Branch Name: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Branch Number: |__|__|__|__|__|__|__|__|__|__|
Type of Account : |__|__|__|__|__|__|__|__|

I__________________________________________________ hereby authorise you to debit my account on the _____ day of each month, as from the beginning of___________20___, with the amount of ___________________(amount in words: _________________________________ ______________________________________________________________________) and deposit it in the current account of the Azanian People's Organisation at First National Bank, Bank City Branch, Johannesburg.

I retain the right to cancel this authority at any time, after due notice has been given.

Signature: ________________________ Date: ___________________

Please send the completed Debit Order Instruction to : Azapo Central Administration, PO BOX 4230, JOHANNESBURG, 2000.