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YNITU
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  • - select a title-
  • Dr
  • Mrs
  • Mr
  • Miss
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  • - select a rank-
  • Registered Nurse
  • Enrolled Nurse
  • Enrolled Assistant Nurse
  • Student Nurse
  • Healthcare Nurse
  • EPWP
  • Healthcare Support Staff
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Your Full Name
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Enter Your Full Name
Your Surname
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SANC No.
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Persal / Employee No.
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  • - select a province-
  • Eastern Cape
  • New Choice
  • Free State
  • Gauteng
  • KwaZulu-Natal
  • Limpopo
  • Mpumalanga
  • Northern Cape
  • North West
  • Western Cape
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  • - select a region-
  • Male
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  • - select an Institution-
  • Eastern Cape
  • Free State
  • Gauteng
  • KwaZulu-Natal
  • Limpopo
  • Mpumalanga
  • Northern Cape
  • North West
  • Western Cape
- select an Institution-
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  • - select a Race-
  • Eastern Cape
  • Free State
  • Gauteng
  • KwaZulu-Natal
  • Limpopo
  • Mpumalanga
  • Northern Cape
  • North West
  • Western Cape
- select a Race-
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Dept / Ward
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  • - select a gender-
  • Male
  • Female
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ID
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Date of birth
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Cell
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Tel (H)
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Tel (W)
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Fax
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E-mail
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Resedential / Postal Address
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  • - select a sector-
  • Public Sector
  • Private Sector
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  • - select a organisation-
  • NGO/NPO
  • Corporate
  • RWOPS
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DETAILS OF REGISTERED RECRUITER


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Name of Recruiter:
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Recruiter Number:
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Contact Number:
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BANK DEBIT ORDER AUTHORIZATION:

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Account Holder (Name)
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  • - select a Bank Name-
  • NGO/NPO
  • Corporate
  • RWOPS
- select a Bank Name-
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Branch Name
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Branch Code
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Account Number
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  • - type of account-
  • Cheque( current)
  • Saving
  • Transmission
- type of account-
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Amount
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Deduction Date
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Start Date
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Signature Reference that will appear on your bank statement YNITU
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Do you agree that:

YNITU use of your information contained in its database to disseminate
information such as notices of general meeting that required. Use of my database information.

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  • - select a option -
  • First choice
  • Second choice
  • Third choice
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  • - select a option -
  • First choice
  • Second choice
  • Third choice
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  • - select a option -
  • First choice
  • Second choice
  • Third choice
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AUTHORITY: I/We hereby authorized you to issue and deliver payment Instructions to your banker for collection against my/our obove mentioned account at my/our above mentioned bank (or any other bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment Instructions will never exceed my/our obligations as agreed to in the Agreement, and commences after the above-mentioned commencement date;

The individual payment instructions so authorized to be issued must be issued and delivered as follows: On the above-mentioned Deduction Date of each and every month commencing on the above-mentioned commencement dote. In the event that the payment day foils on a Sunday or recognized South African public holiday, the payment day will automatically be the very next ordinary business day. Further, if there are insufficient funds in the nominated account to meet the obligation, you are entitled to track my account and re-present the instruction for payment as soon as sufficient funds are available in my account;

I /We understand that the withdrawals hereby authorized will be processed through o computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement or on an accompanying voucher. Such must contain a number which must be included in the said payment instruction and if provided to you u should enable you to identify the Agreement. This number is added to this form (YNITU Membership Number) before the issuing of any payment instruction and communicated to me directly after having been completed by you.

MANDATE: I/We acknowledge that all payment Instructions issued by you shall be treated by my/our above-mentioned bank as if the Instructions had been issued by me/us personally.

CANCELLATION: I/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. we shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.

ASSIGNMENT: I/We acknowledge that this authority may be ceded or assigned to a third party ,f the Agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.

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