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FORM 'C' REMOVE FROM DATABASE - BUSINESS

From
Membership Number
Date 19 May 2012
Please remove the undermentioned from the database as indicated below with immediate effect:
Company Name  
Company Registration Number  
VAT Number  
 
Address 1  *   
Address 2  *  
Address 3  *
Postal Code  *  
Telephone  
Fax  
Contact Person  *  
 
Directors/Members Names and ID Numbers
Name
Identity Number  
 
Name
Identity Number  
 
Name
Identity Number  
 
Please select level of removal
NB: You can only select 'Paid defaulter' if stipulated on your credit application or contract.
 
Captured By  *  
Special Instructions
 
Agreement :
We accept the disclaimer from Accountability as agreed to on our membership application.
We assure you that the above information is true and correct and when clicking on the submit button accept this submission as your approval for Accountability to proceed.
 
 

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