Cape Western Cottages: Pre-Application Questionnaire

P. O. Box 8 Bergvliet 7864

MESCA Telephone / Fax: 021 - 715 5150

CAPE WESTERN COTTAGES: PRE-APPLICATION QUESTIONNAIRE No: /20

Dear Date:

Thank you for your enquiry about MESCA accommodation. These cottages are available to Moths who are eligible to reside there according to the criteria set by MOTH GHQ in order to ensure that the Cottages are administered as per the Constitution and General Standing Orders of the MOTH and MESCA.

Cottages are only available to Moths who:

 Are older than 60, younger than 80 years of age and in good health, (submit copy of ID with application; include copy of partner’s ID where applicable). Note: You may apply before you turn 60.  Have been active Moths in good standing for more than 3 years (attach a copy of your current membership card)

MESCA Cottages will be allocated to qualifying applicants according to the MESCA Cape Western Constitution, using a means test and applying the 3 Ideals of the Order, i.e. True Comradeship, Mutual Help and Sound Memory.

This short questionnaire will enable the MESCA Committee to screen applicants and ensure that available cottages are allocated fairly and managed transparently. Kindly complete the questionnaire below in order for the Committee to determine your eligibility and to place you on the waiting list. Waiting lists will be updated every 2 years.

Please note: There are NO frail care facilities and you will be expected to provide information on your step-down plans and support network on occupation.

Personal Detail: Surname: Names

Address: Code: Contact details: (H): (Cell): Date of Birth: e-mail: Please select: Single Cottage Double Cottage

MOTH Detail: Current Shellhole Yes No When? Positions held: Old Bill/Commander Deputy/Wee Bill Adj Paybill Other: (Please state)

Signature: MOTH confidential – Not for publication Completed documents can be sent to The Chairperson, Moth Daphne Moreira via fax (021 – 715 5150), (snail)-mail (P.O. Box 8, Bergvliet, 7864), or e-mail ([email protected]) Version 5 April 2016