LIDMAATSKAP AANSOEK MEMBERSHIP APPLICATION

Transcription

1 Member Number Reg. 2103/02 LIDMAATSKAP AANSOEK MEMBERSHIP APPLICATION 1. Ons is 'n geregistreerde Brandbeskermingsvereniging (BBV) vir die Groter Overberg-streek (Overberg Distriksmunisipaliteit area). Die BBV beslaan meer as 1 miljoen en sy primêre funksie is brandvoorkoming en brandbestuur strategieë / beskerming. 2. Alle grondeienaars, huurders of gemeenskappe, kan te eniger tyd aansluit by die BBV so lank as u eienaar is van eiendom wat binne die jurisdiksie van die BBV val. Alle staat grondeienaars moet by die BBV aansluit. 3. Die BBV is onderhewig aan die Nasionale Wet op Veld-en Bosbrande Wet 101 van Verwys ook asb na die reëls en Grondwet van die gofpa. 5. Lidmaatskap en lidmaatskapvoordele net vir vol opbetaalde lede. 6. Gemerkte velde is verpligtend in te vul. 1. We are a registered Fire Protection Association for the Greater Overberg region (Overberg District Municipality area). The FPA covers over 1 million and its primary function is fire prevention and fire management strategies/protection. 2. All land owners, lessees or communities, can join the FPA at any time as long as you own property tt falls within the jurisdiction of the FPA. All state landowners must belong to the FPA. 3. We are governed by the National Veld and Forest Fire Act 101 of Further also see the rules and constitution of the FPA. 5. Membership and benefits of membership will only be granted to fully paid up members. 6. Marked fields are compulsory to fill in. 1. LID / MEMBER INFO Naam van grondeienaar of landowner Naam van huurder (indien van toepassing) of lessee (if applicable) Handels naam (indien van toepassing) Trade name (if applicable) Naam van eiendom of property Date: 08/2015 Page 1 of 5

2 2. KONTAK BESONDERHEDE / CONTACT DETAILS Naam Sel Cell Verantwoordelike persoon (Bestuurder) Responsible person (Manager) 2 de kontak persoon (opsioneel) 2 nd contact person (optional) Tel Faks Fax E-pos Taalvoorkeur (merk opsie) Language preference (mark option) Afrikaans English Both 3. REKENING BESONDERHEDE / ACCOUNT DETAILS Naam van rekeninghouer of account holder VAT registrasie nommer VAT registration number Posadres Postal Address Kontak vir rekening navrae (indien nie bestuurder nie) Contact for account queries (if not the manager) Posbus PO Box Dorp Town Poskode Postal Code Naam Tel E-pos Betalingsopsie (merk opsie) Payment option (mark option) Indien koöperasie rekening If co-op account Direk betaling Direct payment Ko-op naam Agri Rekening naam Account name Lid nommer Member number Koöperasie rekening Co-op account Date: 08/2015 Page 2 of 5

3 4. EIENDOM / PROPERTY INFO Fisiese adres Physical address GPS koördinate van plaas werf / kantoor GPS co-ordinates of homestead / farm office Munisipaliteit Municipality Titelakte nommer Title deed number Plaasnaam & gedeelte nommer /Farm name & portion number (eg. Portion 1 of Klipfontein no 234) TOTALE OPPERVLAK TOTAL AREA Oppervlakte Area Landsgebruik skatting Land use estimate Natuurlike veld Natural veld Boorde / Wingerde Orcrds / Vineyards Landerye Cultivated fields Plantasie / Bosbou Plantation / Forest Ontspanningsoord Recreation Industrieel Industrial Date: 08/2015 Page 3 of 5

4 Naam Kontak nommer Contact number Aangrensende bure Neighbouring landowners 5. EIE BRANBESTRYDINGS HULPBRONNE / OWN FIREFIGHTING RESOURCES Item Opgeleide personeel (brandbestryding) Trained personnel (firefighting) Tenkers met kapasiteit >1000l Tankers with capacity >1000l Bakkie sakkie ( l) Skid unit ( l) Spuitkarre Water units Landingstroke Landing strips Hoeveelheid Quantity Ander / Other: Item Hoeveelheid Quantity Waterpunte vir meganiese aanvulling GPS ko-ordinate Water points for mecnical filling GPS co-ordinates 2 rigting radios 2 way radios Nood-kanaal frekwensie Emergency cnnel frequency Date: 08/2015 Page 4 of 5

5 6. LEDEGELDE / MEMBERSHIP FEES Verwys asseblief na die Ledegeld skedule. Lidmaatskap is outomaties getermineer sou n lid NIE die lidmaatskapfooie, kostes en rente (indien van toepassing) binne 90 dae van ontvang van faktuur betaal nie. Please refer to Membership Fee schedule. Membership is automatically terminated should a member NOT pay membership fees, crges and interest (if applicable) within 90 days of receipt of invoice. Verseker asseblief dat ALLE inligting op hierdie vorm korrek en volledig is. Dit is die lid se verantwoordelikheid om die gofpa in kennis te stel van enige veranderinge van die informasie. Die gofpa kommunikeer belangrike informasie met hul lede. Please ensure ALL information is completed ACCURATELY and note tt the onus is on the member to inform the gofpa of any cnges to this information. The gofpa communicates important information to its members. I,...(full name), as land owner or duly authorised representative accept the rules and regulations of this FPA /.../20... Handtekening / Signature Datum / Date Stuur asseblief u voltooide vorm na / Please send your completed form to Of vir navrae kontak asseblief / Or for enquiries please contact info@overbergfpa.co.za, tel , fax Date: 08/2015 Page 5 of 5