ACCOUNT # (For office use only): ………………... APPROVED BY………………………. SIGN……………….
Company Name:
Type of Company (eg: (Pty) Ltd / CC):
Street Address:
Suburb: City:
Zip Code:
Postal Address:
Postal Code:
Tel Number: Email Address:
Company Reg Number: Vat Reg Number:
Bank Name: Branch:
Account Number: Branch Code:
Credit Limit: R
Trade References:
No. Company Name Contact Person Telephone Number
No. Name of Representatives/Partners/Directors ID Number

I/We the undersigned, do hereby warrant my/our authority to act on behalf of the above-named company. I/We agree that all future transactions with Madibana SA shall be governed by and be subject to the Standard Trading Terms and Conditions which appear below this application form and on all Madibana SAWaybills. I/We accept that the Standard Trading Terms and Conditions form an integral part of this application as included in thisapplication


I, the undersigned declares that the information provided in this application form is to the best of my knowledge true, correct, and complete. I also understand that any wilful misrepresentation of the information in this application form will disqualify the application. I hereby grant Madibana SA consent to perform an entity search and checks with any other party (e.g. credit bureau and/or a government agency) relating to this application.

I also declare that:

  1. The entity is not subject to an administration order, judicial management or sequestration or liquidation proceedings or business rescue proceedings as contemplated in the Companies Act 71 of 2008.
  2. The entity is not under debt counselling or subject to debt review.
  3. The entity will not, by entering into an agreement with Madibana SA, becomes over-indebted as contemplated in the NCA.
  4. The entity will pay all amounts due on time, as per signed contract/agreement and as per the invoice terms, from time to time.
  5. There were no blank spaces on any page of this Application on the date that this Application was signed.
  6. By signature thereto, I accept the terms and conditions attached to this Application.

Madibana SA warrants that it will treat the information as confidential and take all necessary steps to protect the information as required by the Protection of Personal Information Act of 2013 (POPI).

We will only disclose the information if

The law requires us to do so.



1. CIPC Registration documents.

2. Director/Representative’s ID Copy.

3. Proof of Business address.



  1. Madibana SA is not a public/common carrier and may refuse to accept any goods for carriage without providing reason for such refusal.
  2. By using our collection and delivery service you agree to be bound by our terms and conditions, as set out below, and you acknowledge that our terms and conditions will constitute a valid, binding and enforceable agreement.
  3. These terms & conditions shall apply to all transactions concluded by or on the Client's behalf on our website. (
  4. A certificate issued by an administrator of our website shall constitute prima facie proof of any fact related to our website, including (but not limited to) which version of the terms and conditions govern a particular dispute and what content was published or functionality was available on our website at a specific point in time.
  5. For purposes of Section 22(2) of the Electronic Communications and Transactions Act, 25 of 2002 you accept that the agreement will be regarded as concludedatAeroport,Spartan,Kempton Park, Gauteng Province,South Africa.
  6. All matters arising from this agreement, its validity, existence or termination shall be determined in accordance with the laws of the time of the Republic of South Africa, and you hereby submit to the jurisdiction of the Magistrates' Court of Kempton Park.
  7. Madibana SA's prices are set out in its price list or are as negotiated or quoted to the Client and are subject to review from time to time
  8. Prices quoted are based on the information provided by the Client. Should this information be found to be incorrect, Madibana SA has the right to adjust the prices based on the correct information while continuing with the carriage.
  9. Any credit limit, invoice frequency, or payment terms set by Madibana SA shall be at its sole and absolute discretion and may be changed by Madibana SA depending on circumstance that Madibana SA believes justifies such changes.
  10. Madibana SA's liability to the Client in respect of goods in its custody: -
    1. Will terminate once proof of delivery has been obtained from the receiving party at the address stated on the Waybill/Airwaybill/Bill of Lading.
    2. Shall exclude indirect and consequential damages.
  11. Any claim for loss must be lodged within 7 (seven) days of such loss by sending an e-mail to . Any claim lodged after such period will not be considered.
  12. All framed pictures, artwork, solar panels, mirrors and negotiable instruments are carried entirely at your risk.
  13. Madibana SA shall not be liable for failure to fulfil its obligations if such failure is due to war, civil disobedience, industrial dispute, act of God, or any event beyond Madibana SA's reasonable control.
  14. If Madibana SA is unable for any reason to effect delivery of the goods, all reasonable steps will be taken to return the goods to the Client. The Client will, however, be responsible for the costs of carriage, attempted delivery and return of the goods. Any failure to deliver or any late deliveries may not be used as motivation for non-payment for that delivery.
  15. Madibana SA will not be responsible for any fulfilment of Customs formalities or payments. However Madibana SA will assist the Client as far as possible, on condition that such assistance will be rendered at the sole risk and responsibility of the Client and the Client undertakes to indemnify Madibana SA against any claims in this respect.
  16. The Client warrants that:-
    1. The goods are accurately described on the Waybill/Airwaybill/Bill of Lading.
    2. The goods are adequately packed and accurately addressed to enable delivery to take place with ordinary care and handling.
    3. The Client has to the best of its knowledge and belief, complied with all laws, rules and regulations regarding the carriage and that the goods are notprohibited by Government regulation.
  17. The Client agrees to Madibana SA’s terms of payment and that Madibana SA shall be entitled to suspend, delay and/or cancel collection and/or delivery of any consignment(s) in the event of non-payment, or to hold the consignment(s) until such time as the account has been settled in full or to Madibana SA's satisfaction.
  18. Failure to pay your account within stipulated times/period or days from the date of delivery of a tax invoice will attract interest at the rate of 24% per annum in terms of the National Credit Act.
  19. You will be liable for all legal costs incurred by us on a scale as between attorney and Client, (including, but not limited to Sheriff's fees, collection commission and tracing agent's fees) in the event of us having to institute legal action in order to secure payment of any outstanding account.
  20. You hereby confirm that a certificate/document signed by one of Madibana SA' senior Managers, showing the amount owing by you to us, shall be sufficient proof that the said amount is due, owing and unpaid and shall be satisfactory proof of what is contained therein for the purpose of any legal action, proof of your debt upon insolvency, or for any other purpose whatsoever. It is also agreed that the company may use any means to verify the information provided by you and in the event of any default, Madibana SA may furnish your details to any registered credit bureau.
  21. No indulgences, latitude, extension of time or the like granted to you shall in any way whatsoever constitute a novation or waiver of any rights which we may have against you, nor may it operate as an estoppel against us.
  22. These Terms and Conditions represent the entire agreement between the parties. Any changes to these conditions must be agreed to in writing to be of any force or effect.