NEHAWU Member Application Form
Member Personal Information
Title	Mr Mrs Miss
First Names
Initials
Surname
Identity Number
Date of Birth
Language
Gendar	Male Female
Marital Status	Single Married Divorced Widowed
Number of Dependants
Member Address Information
Postal Address
	Postal code
Physical Address
	Postal code
Telephone (work)
Fax
Telephone (home)
Mobile Number
Email Address
Employer Information
Date Employed
If you work for a Government Organisation, please complete the following section:
Department Code
Department / Organisation Name
Paypoint Code
Paypoint Name
If you work for a Private organisation, please completed the following section:
Employer
Postal Address
	Postal code
Occupation / Position
Date commenced in this position
Salary	R
Salary Frequency	Monthly Weekly Forthnightly Other
Salary Number
Subscribtion Payment Details
Method   Cash Debit order Credit card  Frequency   Weekly Forthnightly Monthly  Amount R
If you pay by Debit Order, please complete your Bank Details:
Bank Name
Bank Branch Code
Account Holder
Bank Account Number
Account Type	None Current Savings Transmission Bond Subscription Shares
Membership Details (For Office Use)
Membership Type	Member Site / Shop steward
Recruiter Details
Recruiter Member Number
Recruiter Surname
Recruiter ID Number
STOP ORDER FORM
I, hereby authorise you to deduct 1.161% (not exceeding R57.00) of my income each month. The first deduction to be made on  and be credited into the union account within seven days of the beginning of each month on the following conditions: 1. The deductions, which are made in respect of my monthly subscriptions, will be made in accordance with the current subscription rate subject to changes of which you will be duly informed. 2. Cancellation of this authorisation is subject to the provisions of the Union's constitution and section 13 of the Labour Relations Act of 1995. 3. I hereby revoke any previous authorisation for deductions in respect of any Union or staff association.