Application for Payments to Third Persons Information
hereby inform PASA, in terms of the Directive for Payments to Third persons, Directive No. 1 of 2007, that we sponsor the following institution and confirm that they are corporate clients of our bank.
We hereby wish to inform PASA of our client's details for purposes of authorisation as a Third Party Payments provider:
Fields marked with an * are mandatory
Full Name of Institution *
Contact Person *
Physical Address *
Physical Code *
Postal Address *
Postal Code *
Office Number *
Fax Number
Cell Phone Number
E-mail address *  
The applicant provides/will provide services in respect of the following:

Full Name *
Contact Number *
E-mail address *