UTATU Application Form

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Application Form

PERSONAL DETAILS

Title:

Surname:

Date of Birth:

Postal Adress:

Home Address:

Telephone (Home):

Telephone (Work):

Cell:

E-mail Adress:

ID Number:

EMPLOYMENT DETAILS

Employment Details:

Company Name:

Occupation:

Employee Number:

Grade:

Centre:

BENEFICIARY DETAILS

I, the undersigned, a member of the UTATU hereby nominate and appoint the following to be my nominee/s. This death grant shall form no part of my legal estate and shall be neither executable nor attachable at the instance of any creditor of mine, but shall be paid direct to my nominee/s.

NOMINEE 1

Full Name:

Identity No.:

of Address:

NOMINEE 2

Full Name:

Identity No:

of Address:

BANKING DETAILS

FORMULA FOR CALCULATING SUBSCRIPTION: Membership fee is 1% with minimum of R35 and max of R60.00 I, the undersigned, hereby request Transnet to deduct monthly from my salary the amount determined by application of the above formula and to pay this amount to UTATU. It is clear to me that this stop order can only be cancelled by giving one monthâ€™s written notice to the General Secretary.

THIS DEBIT ORDER CANCELS MEMBERSHIP OF ANY OTHER UNION

Bank:

Branch:

Branch Code:

Account No.:

Account Type:

REFERER DETAILS

If you were referred or recruited by another UTATU Member, please provide the following:

Referred by:

Address:

Postcode:

Telephone No:

Required field