Debtors Department

SAMBRA DEBTORS DEPARTMENT

Company details:

Company name:

Contact person:

CONTACT DETAILS

Tel:

Cell:

Email:

Membership no:

CLAIM DETAILS

Customer name:

Debtor's name (insurance comp./ Broker):

Claim/authorisation no:

Vehicle (Make/model):

Registration no:

Invoice no:

Final amount (incl. VAT):

Date of invoice:

Date of release:

I the undersigned hereby grant the South African Motor Body Repair Association the right to assist me in recovering the above mentioned outstanding amount for the relevant claim.

Name and surname:

Date:

TERMS AND CONDITIONS

  1. All invoices must be overdue for a period greater than 45 days.
  2. The member shall lodge a fee of one per cent or minimum of R250 per claim with SAMBRA. This fee is refundable if SAMBRA should fail to assist you with the recovery of the outstanding debt.
  3. No claim will be handled prior to the lodgement of the above fee.
  4. All the necessary details will need to be fi lled out and the duly authorised representative will have to sign the document prior to it being lodged with SAMBRA.
  5. SAMBRA will from time to time request additional paperwork/documentation if deemed necessary.
  6. SAMBRA cannot be held liable for the payment of this claim.
  7. Members will be paid their claims directly from the debtor as in the ordinary course of business and SAMBRA will assist with the facilitation of the payment.