Eastern Cape Application Form

Complete the form below to join NAPTOSA Eastern-Cape!

Name *

First

Last

Title and Initials *

ID Number *

Date Of Birth *

Cellphone Number *

Personal Email Address *

Confirm Email

Full Home Address *

Please remember to include your postal / residential code!

School / College / Office *

Persal No

SACE no

Branch / District / Area *

Physical Work address *

Please include the postal / residential number!

Please select an option below for your membership application: *

Please specify your job title e.g. Teacher, Psychologist, Therapist, Nurse, General Assistant etc. *

Were you recruited by a NAPTOSA Member? *

Select An Option

Recruiter Membership no (if applicable)

Recruiter Name & Surname

First

Last

How Many Dependents Do You Have? *

Please list only the number of dependents you have.

Please Provide Us With The Full Names, Surnames, ID Numbers and Contact Details of All Your Dependents: *

Be as detailed as possible.

Dropdown *

Please note that this form includes your Funeral Beneficiary nomination and by signing the form you declare that you understand that this beneficiary nomination cancels all previous nominations, if any, that you have made with respect to the NAPTOSA Funeral Scheme payable by SAFRICAN.

I hereby nominate the following person as the beneficiary of my NAPTOSA Funeral benefit in the event of my death: (NOTE: The Funeral Benefit will be paid into your estate if we do not have a valid Beneficiary Nomination form)

Main Beneficiary Details: *

First

Last

ID/ Passport number *

Date of birth: *

Relationship *

Contact Telephone No *

Personal Email Address *

Confirm Email

Secondary Beneficiary Details: *

In the event that the main beneficiary nominated above has passed away before the effective date of my death, they will be excluded from receiving the portion he/she was nominated to receive, and the following nominated beneficiary will receive any benefits payable:

Secondary Beneficiary Details: *

First

Last

ID/ Passport number *

Date of birth: *

Relationship *

Contact Telephone No *

Personal Email Address *

Confirm Email

Change of Circumstances: *

If your circumstances change, for example you get married or divorced or have a child or a nominated beneficiary dies, and you want to change your beneficiary, you must complete a new nomination form.

Bank Details: *

Please specify the name of the bank where your account is held?

Account Number: *

Please specify the number of the account, as well as the type of the account that you want to be debited at the end of the month?

Name of Account: *

Please specify the name of the account?

Branch: *

Please specify the name of the branch and the branch number where your account is held?

Contractual Agreement *

I confirm that my membership fees will be paid to NAPTOSA by the Department of Education as indicated below:

To:
HEAD : Department of Education

I, the afore-mentioned, and undersigned, hereby authorise you to deduct monthly from my salary my subscription due to the National Professional Teachers' Organisation of South Africa (NAPTOSA) R111.40 per month or such subscription as is determined from time to time by NAPTOSA and pay it to NAPTOSA [PERSAL Table 139 Code 026]. I understand that any correspondence in connection with this stop order must be directed to NAPTOSA.

Electronic Agreement *

By ticking this electronic form, I confirm that the information provided is true and correct. I also agree to the Terms and Conditions of NAPTOSA and agree that my submission adheres to the South African Common Law and the Electronic Communications and Transactions Act (Act no. 25 of 2022)(“ECTA”), with regards to my electronic consent to this agreement.

For Office Use:

NAP Member Code

Date Uploaded to Q LINK:

Date

Complete the form below to join NAPTOSA Eastern-Cape!

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