Affiliate Member Application Form

    A – PERSONAL DETAILS:


    B – EMPLOYER DETAILS:


    C – NOMINATION OF BENEFICIARY: (for the payment of Death Benefits):

    The person whom the benefits, in terms of the Rules of MISA BENEFIT and FUNERAL FUND, shall be paid in the event of my death.

    PLEASE NOTE

    Affiliate members of MISA need to pay subscriptions to MISA directly, in advance. Kindly note that the relevant waiting periods still apply.

    BANKING DETAILS

    MISA Active Member Contributions, Nedbank, Acc: 1513015354, Branch code: 198765. Kindly use your ID number or passport number as reference.

    DECLARATION

    I, the undersigned, solemnly declare that the above particulars are true and correct, and I agree to abide by the Organisation’s Constitution and faithfully observe all rules and regulations which are in force, or may be brought into force, from time to time. Consent in terms of Act 4 of 2013 (Protection of Personal Information Act): I hereby authorise MISA to process my personal information (as per my membership application form) as well as to provide the necessary information of my MISA membership to my employer in so far as it is necessary to protect and/or execute my interests and/or those of MISA. PLEASE NOTE: It is your responsibility to notify MISA if and when any of your information changes regarding your membership. This includes your personal, company and beneficiary details.