I hereby authorize Yayasan Konservasi Alam Nusantara, in this case called YKAN, domiciled in Jakarta (hereinafter referred to as the Proxy) with substitution rights to the Bank/Credit Card Issuer to debit the Authorizer's account/Credit Card as mentioned above for payment purposes. Donate to YKAN on behalf of the Account/Credit Card Owner mentioned above.
Stipulations:
- Application & Power of Attorney for Account/Credit Card Debit is valid from the time it is signed.
- Cancellation/Termination of participation and authorization to debit Account/Credit Card is effective 1 (one) month from the date of receipt of notification letter from the Authorizer regarding cancellation/termination.
- If later it appears that the amount debited does not match the amount written above, the Authorizer agrees to claim the amount directly to YKAN.
- The Authorizer is fully responsible for the correctness of the information provided in the Debit Application & Power of Attorney.
- The Authorizer gives written approval to YKAN to use the personal data contained in this form and to transfer such data to Third Parties, namely Banks and Data Security Entities for donation purposes and in accordance with applicable laws and regulations.
- For regular donations using BNI or BRI account, your donation will be automatically debit every month according to the account number you provided.
- Any consequences arising in connection with this Authorization shall be the full responsibility of the Authorizer and hereby release the Bank/Credit Card Issuer from all claims of any kind and or any claims from any third party.