Debit Order Form | CPD | Focus On Health

FoH Number*

ID Number*

New Delivery Option*

E-mail
Courier
Online
Paxi to PEP Stores

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Select a payment option*

Once-off payment
Monthly payment

Banking Details
Bank Name: ABSA
Account Type: Cheque
Account Nr: 405 843 7431
Branch Code: 632 005
Ref No: HPCSA no

Debit Order Details
Membership runs from January to December of each year. Therefore the debit order amount will depend on the month in which you join. A membership fee of R125 will be added to the first month’s installment. If applicable, the courier cost of R70 will also be deducted with the first month’s installment. Thereafter only the installments as set out below will be deducted until December 2016.

When did you open your account at your Current Bank?*

Bank Name*

Type of Account*

Account Number*

Branch Code*

Branch Name*

Account Holders Name*

Preferred Debit Order Date*

1
15
25
30

Abbreviated name as it will appear on your bank statement*

ID Number*

Additional comment

Confirm you agree to the terms and conditions below*

Focus on Health membership represents an annual subscription. Membership fees will be due and payable once Focus on Health has emailed, couriered, posted or personally delivered accredited activities to the member. When an activity is posted, a “test” envelope is included in each batch to check delivery. For the members’ convenience, membership is renewed on the last day of the applicable calendar year. Following which Focus on Health will provide the member with his/her CPD activity for that year. All membership cancellations should be submitted twenty (20) business days on or before the renewal date on 1 January of each year. Focus on Health will supply the member with his/her CPD activity via the selected delivery option and details provided above. It is the members’ responsibility to inform Focus on Health of any changes. Please contact us within 2weeks after submitting this application, if you did not receive your CPD activity. Please contact us if you did not receive your membership number via SMS within 24-36 hours.All correspondence and receipt of payments sent to Focus on Health will be confirmed via SMS to the member. Please note that when you use a promotional code to become a member, other discounts may not apply.

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