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<p> Tel: 012 346-1081 Fax: 012 346 1082 E-mail: [email protected] APPLICATION FOR MEMBERSHIP PLEASE PRINT, COMPLETE AND FAX TO (086 694 5444)</p><p>I:………………………………………………………………………………………………………………..hereby apply on behalf of……………………..………………………………………………………………….(CC) for membership of MicroFinance South Africa (MFSA) as from the month of ______20___ and undertake to pay the inclusive monthly subscription of R 872.10 or the annual amount of R 10,465.20 (or as may be adjusted from time-to-time) and to abide by the Articles of Association at all times. I understand that in terms of the Statutes, all membership rights lapse after three (3) months of non-payment of subscriptions, and in the case of me wishing to terminate my membership I will notify the MFSA with 3-month’s notice. </p><p>BUSINESS NAME:______</p><p>Postal Adress______</p><p>Town______Postal Code:______Region:______</p><p>Business Address______</p><p>______</p><p>Tel: (_____)______Fax:(______) ______</p><p>E-mail address:______</p><p>NCR / No:______Business Registration: ______</p><p>VAT NO:______</p><p>CONTACT PERSON: Mr/Mrs/Me:______ID:______Cell No:______</p><p>Registration number: 1996/001116/08 Surname:______Names:______</p><p>Signature:______Date:______</p><p>ASSOCIATE MEMBER ONCE OFF PAYMENT R 10 465.20 or monthly R 872.10</p><p>Enquiries Members: Uncial [email protected] Accounts: Dorien [email protected]</p><p>THE ABOVE AMOUNTS ARE INCLUSIVE OF VAT Type of payment: Cheque Cash Bank deposit Debit order (Fax deposit slip to) 012 346 1082</p><p>2</p>
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