Download - FICCA membership form (1)
FICCA (Financial Industry and Call Centre Association) 13 VAN RENENS VIEW, WEBBER STREET, HORIZON VIEW. www.ficca.co.za email [email protected]
FINANCIAL INDUSTRY AND CALL-CENTRE ASSOCIATION
HEAD OFFICE DETAILS 13 VAN RENENS VIEW
WEBBER STREET
HORIZON VIEW
e-mail: [email protected]
FICCA MEMBERSHIP FORM
SURNAME: ______________________________________________________
FIRST NAME(S): _________________________________________________
TITLE: MR MRS MISS MS
ID NUMBER:
LAND LINE: ( ) ______________________
CELL: _________________________________
E-MAIL: ________________________________________________________________________
EMPLOYMENT DETAILS
NAME OF EMPLOYER:________________________________________________________________________
EMPLOYER ADDRESS :_____________________________________________________________
PROVINCE:_____________________________________________________________
DEPARMENT:_______________________________________________________________________________
EMPLOYEE NUMBER:______________________
POSITION:______________________________________________________________________
PLEASE INDICATE YOUR LINE OF BUSINESS:
SALES: RETENTIONS: CLIENT SERVICES: MARKETING: QA:
LEGAL: HUMAN RESOURCES: IT:
PLEASE SPECIFY IF OTHER POSITION: ________________________________________________
PLEASE INDICATE YOUR EMPLOYMENT STATUS:
PERMANENT: TEMPORARY: CONTRACT: COMMISSION BASED:
FICCA (Financial Industry and Call Centre Association) 13 VAN RENENS VIEW, WEBBER STREET, HORIZON VIEW. www.ficca.co.za email [email protected]
BANKING DETAILS
NAME OF BANK: ____________________________________________________
BRANCH:__________________________________________________________
BRANCH CODE: ____________________________________________________
TYPE OF ACCOUNT: SAVINGS : CHEQUE: TRANSMISSION:
ACCOUNT NUMBER:
DEBIT DATE (PLEASE TICK 1): 1st 7th 15th 27th
ACCOUNT HODER: ____________________________________________________
ACCOUNT HOLDER’S SIGNATURE: ________________________________________
DEBIT ORDER AUTHORISATION
I ________________________________the undersigned agree__________________(place)_______________________
(date)___________to pay FICCA monthly subscriptions as determined by the FICCA from time to time and authorise you to recover my
subscription from my bank account.
STOP ORDER AUTHORISATION / IF APPLICABLE
I__________________________________the undersigned agree__________________(place)_________________________
(date)____________authorise FICCA to implement the following deduction on my employment number and deduct my monthly subscription
which may be determined by FICCA from time time.
I hereby authorise a deduction of R55.00 from my salary/commission account each month, payable to FICCA.
SIGNATURE: ______________________ DATE: ________________________
Please complete this form and e-mail it to [email protected]
FICCA (Financial Industry and Call Centre Association) 13 VAN RENENS VIEW, WEBBER STREET, HORIZON VIEW. www.ficca.co.za email [email protected]
Debit order and stop order Terms and Conditions
You, the Member,
1.I instruct and authorize FICCA to draw against my nominated account (or any other bank acknowledge that:or bra
nch to which I many transfer our account) the amount necessary for payment
of the monthly membership fee due in respect of the membership, on the day nominated by me each and every mont
h and continuing until termination of our agreement or until cancelled by me in writing.
2. All such withdrawals from my bank account by FICCA will be treated as though they had been authorized by me
personally
3.The withdrawals will be processed through a computerized system provided by the South African Banks and that d
etails of each withdrawal will be printed on my bank statement.
4.I agree to pay any bank charges relating to this debit order instruction.
5.The authority may be cancelled by me by giving thirty days’ notice in writing
6.If the authority is cancelled by me I understand that I shall not be entitled to any refund of amounts which FICCA
has withdrawn while this authority was in force, if such amounts were legally owing to FICCA.
7. Receipt of this instruction by us shall be regarded as receipt thereof by my bank whichever it is or will be)
8. I acknowledge that the party hereby authorized to effect the drawing(s) against my account and may not cede or a
ssign any of its rights to any third party without my prior written consent and that I may not delegate any of my obli
gations in terms of this authority to any third party without prior written consent of the authorized party.
SIGNATURE: ______________________ DATE: ________________________