Your Details
Select your Membership option
Teacher, Healthcare Professional and Enforcement Officer benefit (optional)
Add extra cover to your plan. Each add-on is billed monthly on top of the plan premium.
Physical Address
Enter your postal code, then choose your suburb to fill in the city and province.
Postal Address
Enter your postal code, then choose your suburb to fill in the city and province.
Marketing Consent
Select the day of the month you'd like your premium to be deducted
Universal branch code auto-filled for this bank
This must match the name registered with your bank
Debit Order Authorisation
You hereby authorise LegalWise South Africa (RF) (Pty) Ltd (LegalWise) as a non-mandated intermediary of Legal Expenses Insurance Southern Africa Limited (LEZA) (the Insurer), to arrange a monthly premium deduction(s) and/or deduction(s) of arrear(s) by means of a Debit Order from your nominated bank account. You acknowledge that all payment instructions issued by LegalWise and LEZA shall be treated by your above-mentioned bank as if the instruction has been issued by you personally. You may not delegate obligations in terms of this authority to a third party without prior written consent from LEZA. You acknowledge that LEZA may not cede or assign any of its rights to a third party without your written consent. LEZA is entitled to track your account monthly with DebiCheck or any other similar system. If the deduction is unsuccessful to meet the obligation, LEZA will re-present the instruction for payment on alternative dates, when the obligation in terms of the LegalWise Membership Agreement is due. The reference on your bank statement will reflect as LEGALWISE. This authority will continue until cancelled by you by giving LEZA thirty-one days' written notice.
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