FICCA (Financial Industry and Call Centre Association) 13 VAN RENENS VIEW, WEBBER STREET, HORIZON VIEW. www.ficca.co.za email info@ficca.co.za

FINANCIAL INDUSTRY AND CALL-CENTRE ASSOCIATION

HEAD OFFICE DETAILS 13 VAN RENENS VIEW

WEBBER STREET

HORIZON VIEW

e-mail: info@ficca.co.za

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 info@ficca.co.za

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 info@ficca.co.za

FICCA (Financial Industry and Call Centre Association) 13 VAN RENENS VIEW, WEBBER STREET, HORIZON VIEW. www.ficca.co.za email info@ficca.co.za

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: ________________________