Please select you province (Required) Western CapeEastern CapeFree State/Northern CapeKwaZulu-NatalNorthern/Highveld
Please select you Benefit (Required) Gold Membership - R41 per weekSilver Membership - R35.50 per weekBronze Membership - R20.50 per week
Surname ( Mr / Mrs / Ms ) (required)
Marital Status: (required) SingleMarriedDivorcedWidowed
Date of Birth (required)
Please upload copy of your ID (file limit 2mb, file type: pdf,jpg,png)
Full Names (required)
Maiden Surname (if applicable)
Identity No. (required)
Postal Address
Tel
Email
Have you previously been registered as a member of MISA YesNo
Cell
Your present Occupation (What is your Job Title at present)
Membership No.
Name of Company (required) Street Address Email
Tel Postal Address Fax
Are you qualified? YesNo
Please tick the correct box ApprenticeOperative engine assembler in an engineering establishmentExempted journeyman in vehicle body building establishmentEmployee doing aspects of journeyman’s work under exemptionOther
If you are an employee in the Motor Industry, and you are performing the work of an artisan, you are required to attach proof of your qualification(s): (All documentary proof must be certified.)
Completed apprenticeship contract
Trade test diploma
Certificates of service confirming the practical experience gained whilst performing work in a designated trade
Do you have the necessary documentation? YesNo
Please select you province -please select-Western CapeEastern CapeFree State/Northern CapeNatalNorthern/Highveld
Please mail your documentation to wp@ms.org.za
Please mail your documentation to ep@ms.org.za
Please mail your documentation to fs@ms.org.za
Please mail your documentation to natal@ms.org.za
Please mail your documentation to northern@ms.org.za
Please select your documents and use the browse button to upload your documents. (File size limit 2mb, file types pdf,jpg,png) Completed apprenticeship contractTrade test diplomaCertificates of service confirming the practical experience gained whilst performing work in a designated trade
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.
I hereby nominate Mr / Mrs / Ms (Surname) Marital Status: SingleMarriedDivorcedWidowed Cell / Tel
Full Names I.D. No./Date of birth Relationship (Spouse, Son, etc.)
Address
I, the undersigned,
hereby further authorise and instruct my employer to deduct, and pay over, on a monthly basis the union subscriptions payable by me to MISA or its designated agent.
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 or its designated agent, to process my personal information (as per my membership application form) as well as to provide the necessary information of my MISA membership to MIBCO and 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. Please also ensure that MISA union fees are being deducted from your payslip monthly.
Signature (please sign below with your mouse or finger)(required)
Date (required)
Δ
