NUPSAW Membership Application

SECTOR
PRIVATE PUBLIC TITLE (Dr, Mr, Mrs, Ms)
INITIALS
FIRST NAME (S)
DATE OF BIRTH
SURNAME
MARITAL STATUS
IDENTITY NO
GENDER
FEMALE MALE ADDRESS

WORK
HOME
CELLPHONE
FAX (w)
E-MAIL ADDRESS

DEPARTMENT
ADDRESS
TOWN (CITY)
POSTAL CODE
RANK/OCCUPATION
PERSAL/SALARY NO
PAYPOINT NO

FIRST NAME
SURNAME

Own children (Biological children): up to the age of 21 as well as children who are full-time students up to the age of 25

INITIALS	NAME(S)	SURNAME	DATE OF BIRTH	RELATIONSHIP

I the undersigned, hereby authorize Department/Company to implement the following deduction on the Persal/Payroll system and to deduct my monthly membership fee of R70 or 1% of my basic salary, whichever is the greater, up to a maximum of R90.

Salary/Persal number
AS FROM

I understand that three (3) months for public sector and one (1) month for private sector written notice of revocation is required prior to terminating my membership and this stop order. Where payment is made into NUPSAW banking account, proof of payment must be faxed to Head Office (fax 086 667 8362) reflecting the following information: name, surname, member number, contact details and period for which payment is made.