Mandate & Billing Requests
Request Type
(Required)
New mandate request
Arrear debit request
Agent
(Required)
Select…
Bathabile Moya
Colleen Sigabi
Dyllan Kreigisch
Noluthando Nkomo
Phumza Ngcobo
Regan Anthony
Vivian Molefe
Zanele Mgudlwa
Operations Team
Category
(Required)
Select…
Account detail update
Billing day update
Cancellation request
Mandate rejected
Mandate suspended
Payment failure
Payment reversal
Premium change
Reinstatement
Waiting for approval
Other
Category
(Required)
Select…
Other
Payment failure
Payment reversal
Policy Number
(Required)
Contract Number
(Required)
Request New Mandate
(Required)
Yes
No
Amount
(Required)
Day
(Required)
Select…
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
(Required)
Select…
January
February
March
April
May
June
July
August
September
October
November
December
Year
(Required)
Select…
2026
2025
2024
2023
2022
2021
Status
(Required)
Open
Closed
n/a
Outcome
(Required)
Retained
Not retained
n/a
Disposition
(Required)
Select…
Account detail update
Added benefits
Affordability
Agreed to accept mandate
Arrears collection
Better offer
Billing day update
Cash payment
Complaint resolved
Debit order issue
Decreased cover
Discounted premium
Dishonest client
Duplicate lead
Escalation
Failed verification
Hang Up
Incorrect start date
Increased cover
Invalid number
Invalid sale
Lapse overdue
Lead exhausted
Leaving country
Manual debit
New mandate request
No answer
No contact information
No longer interested
NTU overdue
Payer issue
Policy claimed
Policy documents not received
Policy reissued
Previously cancelled
Previously lapsed
Previously NTU
Removed benefits
Rescheduled
Resold benefits
Retrenched
Unemployed
Unhappy with benefits
Unhappy with service
Unreachable
Voicemail
Void policy
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