Application Form for Admission To

APPLICATION FORM FOR ADMISSION TO THE INSTITUTE OF RISK MANAGEMENT SOUTH AFRICA as an Individual Member

Membership Terms and Conditions 1. Please email your completed application form and all supporting documentation to [email protected] 2. All emailed documentation must be certified as true copies of the originals. 3. A non-refundable application fee of R250.00 (excluding VAT) applies to all applications. 4. Membership fees are renewable annually. The 2017 Membership Fees are as follows: *Note – Corporate Member Employees receive a 20% Discount on the below fees

2017/18 Membership Fees Exclusive of VAT Inclusive of VAT Individual Member 1236.84 1410.00 2017/18Membership Fees – Corporate Member Employees (20% Discount for Members employed by IRMSA Corporate Members) Exclusive of VAT Inclusive of VAT Individual Member (Corp Empl) 986.84 1125.00 5. The membership year runs from 1 March to the last day of February. 6. Applications approved and ratified from 1 September pay half the full membership for that year. 7. All applications for membership will be presented to the Membership Committee and a recommendation presented to the Institute of Risk Management South Africa (IRMSA) Executive Committee (EXCO) for final approval. The final decision is at the discretion of the EXCO. 8. It takes approximately 30 days for Individual Membership Applications to be processed 9. Upon receipt of the completed application form, an email will be sent confirming receipt of the form. An invoice will also be sent in a separate email. The application will then be sent to the Membership Committee for review and a recommendation will be made to EXCO for final approval. Thereafter feedback will be sent to you regarding your application. Provided proof of payment has been emailed to [email protected] , you will be emailed your Membership Certificate and Acceptance Letter accordingly. 10. Should your application be successful and your membership invoice is not settled within two months, you will be removed from the system and will be required to start the entire application process again. 11. Please note further information may be requested to accurately determine the level of membership. 12. Individual and Associate Members who become eligible for reassessment of membership status on the grounds of additional experience gained, improved academic status or contributions to the activities of the Institute of Risk Management South Africa should re-apply to the Institute. Full registration fees will be payable. 13. An Associate Member of The Institute of Risk Management South Africa may use the designation RMA-IRMSA after his/her name. A Fellow Member may use RMF-IRMSA after his/her name. Please note use of the IRMSA logo is reserved for use by Corporate Members only and its use by Individual Ordinary, Associate and Fellow Members is not allowed. NOTE: COPYRIGHT OF THIS MATERIAL EXISTS WITH THE INSTITUTE OF RISK MANAGEMENT SOUTH AFRICA

THE INSTITUTE OF RISK MANAGEMENT SOUTH AFRICA APPLICATION FOR CONSIDERATION AS AN INDIVIDUAL MEMBER OF THE INSTITUTE

1. Your Details: Title Surname First Name/S Initials Date Of Birth South African Identity Number Non SA Passport Number Demographics (please circle) BA (Black: African) (Please note this is for SAQA BC (Black: Coloured) record purposes on the BI (Black: Indian/Asian) National Learners’ Records Wh(White) Database) ATTACH: Certified Copy of ID (SA Residents) or Passport (Non SA Residents)

2. Employer Details: Current Employer Your Position Work Tel Work Fax Work Email Postal Address Postal Code Physical Address VAT Number ATTACH: Proof of Employment Y N

3. Is your Organization an IRMSA Corporate Member?

4. Home Contact Details Postal Address Box Number Postal Code Area/Province/State/Country Physical Address Building Number and Name Street Number Street Name Suburb/City Province/State/Country Contact Details Tel Number Cell Number Other Contact number Personal Email

1. Educational and Professional Experience

1.1 Education History

Completed Studies (Qualification, Subjects, Name of Institution and Year Awarded)

Current Studies (Qualification, Subjects and Name of Institution)

Short Courses (Qualification, Subjects and Name of Institution)

1.2 Professional or Academic Qualifications

Professional Qualifications e.g. CA (SA), CIA etc. (Institution, Date Awarded)

Membership of Professional Associations: (Name of Association, Member Details)

2. Experience

2.1 Risk Management Related Experience

Number of Years of Risk Management Experience:

2.2 Other experience

Number of Years of Other Experience:

2.3 Specify field of expertise

Banking & Financial Services Mining Oil & Gas Education Shipping & Logistics Electronics, Telecoms and Communications Tourism & Hospitality Insurance / Re-Insurance Trading & Distribution Engineering: consultancy and Industrial Machinery construction Medical & Pharmaceutical Petrochemicals & Chemicals. Professional Services Other (Please Specify) Technology

2.4 What is your focus? Operational Risk Strategic Risk Both

3. Contributions to Risk Management If the following information is not detailed in your CV, please provide us with: Full details of articles published (Title and Printing Medium)

Lecturing, Teaching and Training (Name of Lecture / Course Material and Where Provided)

4. What is your primary reason for joining IRMSA? Networking Professional Development and Education Tools and Resources Marketing

5. How did you find out about IRMSA? Internet/Website Publication – please specify : Email Colleagues Other – please specify:______

6. Provide a Brief Motivation / Reasons Why You Wish To Belong to the Institute:

Checklist – please ensure you have attached the following with your completed signed application form and agreed to the Terms and Conditions:

 Certified Copy of ID (SA Residents) or Passport (Non SA Residents)  Proof of Employment (Non SA Residents) – a letter from employer stating position, date of commencement of employment, current dated, signed. For further information contact Lucia IRMSA (011) 555 1800 or [email protected]