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PROUDLY THREE RIVERS MEMBERSHIP AND CONTRIBUTION FORM

Membership & Contribution Form

PERSONAL INFORMATION

Please provide your details below. All fields marked with an asterisk (*) are mandatory.

CONTRIBUTION DETAILS

Please indicate your preferred payment method and contribution amount.

Section 18A Certificate

If YES, please provide the following details:

DEBIT ORDER INSTRUCTIONS

Complete this section if you select Debit Order as your payment method.

I/We hereby authorize Proudly Three Rivers NPC to draw against my/our account with the bank listed below (or any other bank or branch to which I/we may transfer my/our account) the amount indicated on the 1st or 20th day of each month, commencing on and continuing until termination of our agreement or cancelled by me/us in writing with thirty (30) days’ notice.

I/We understand that withdrawals will be processed through a computerized system provided by South African banks, and details of each withdrawal will appear on my/our bank statement. All withdrawals shall be treated as though personally signed by me/us. This authority may not be ceded or assigned to any third party without my/our prior written consent, and I/we may not delegate any obligations under this agreement without the prior written consent of Proudly Three Rivers NPC.

BANK DETAILS FOR EFT PAYMENTS

For Electronic Funds Transfer (EFT) payments, please use the following bank details and include your name as payment reference.

Account Name: Proudly Three Rivers NPC

Bank: Absa

Account Number: 4092267335

Account Type: Current

Branch Code: 632005

POPIA Consent

All personal information collected and maintained by Proudly Three Rivers NPC will be handled in accordance with the Protection of Personal Information Act 4 of 2013 (POPIA). By signing this form, I/we consent to the collection, processing, and disclosure of my/our personal information to relevant third parties where necessary for the purposes of membership and donation processing.

Declaration

I/We confirm that the information provided is accurate and agree to the terms outlined in this form.

The founding members of the group came to the realization that unless members of the community were to get actively involved on a personal level, infrastructures in Three Rivers would drastically deteriorate to the point where families would no longer be able to live a dignified life in an acceptable, safe and healthy environment.

 

DIRECTORS

Chris Johnsen (Chairman & Finances)
Harry Katrakilis (Municipal Liaison)
Chris De Wet (Marketing)
Frik Wepener (Road Repairs and Park Maintenance)
Bonita Andrews (Administration)

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PROUDLY THREE RIVERS

River Square Mall
Cnr General Hertzog & Nile Drive
Entrance 4
Shop P2B

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ADMIN OFFICER

Bonita Andrews

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EMAIL

info@proudly3rivers.co.za

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TELEPHONE

060 5620816

Proudly 3 Rivers - Store Front
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Office hours: Mondays to Fridays: 8:00 to 12:30

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PROUDLY DESIGNED BY BUNNYPANTS GRAPHIC AND WEB DESIGN STUDIO | 2022