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  To join Labour Protect complete the following Application Form...

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APPLICATION FORM
APPLICANT'S DETAILS:
First Name 

Surname

Title
Postal Address Code
Physical Address Code
Identity Number

Email Address

Telephone Number   Cell Number
 
SELECT PREFERRED OPTION:
I wish to pay R85.00 each month by debit order on my bank account.
  Name of Bank Branch
  Branch Code Account Number
  Type of account:                    savings             transmission              cheque
  Date of preferred monthly deduction:             1st             15th              25th
I enclose a cheque for R1020.00 being one year's membership fee.
 

Signature: _________________________________

(Please note: Membership Rules apply)
 
 

Referred by: (if applicable) 

 
 PRINT PAGE before signing and forwarding it by fax or post to Labour Protect ...

(Admin/ Membership Queries: (021) 421 8631 / Telefax: (021) 425 0875;  PO Box 8397, Roggebaai, 8012)