Membership Application Form

*For Office Use

Membership Number

I hereby apply to be admitted as NWAFASA member:

A: PERSONAL INFORMATION

Surname
First Name
ID Number
Local Municipality
District Municipality
Postal Address
Postal Code
Name of Farm / Village
Physical Address of Farm / Village
Postal Code
Cell Number
Tel Number
Fax Number
Email address

B: OTHER MEMBERSHIP & AFFILIATIONS

* Please tick in box & indicate details of membership or affiliation

	YES	NO	NAME / DETAILS
Do you belong to a study group?
Do you belong to a commodity association?
Do you belong to a local primary farmers’ co-operative?

C: FARMING INFORMATION

* Please tick in box & indicate size of land in appropriate spaces

Communal Land		Size of Land (ha)
Leased Land		Size of Land (ha)
Own Land		Size of Land (ha)
Other Tenure		Size of Land (ha)

D: FARM ENTERPRISES

* Please tick in appropriate box the commodity, enterprise(s) and size of your farm operation

Aquaculture
	Description		Size (ha)

Crop/Grain
Beans		Size (ha)
Lucerne		Size (ha)
Maize		Size (ha)
Sorghum		Size (ha)
Soya		Size (ha)
Sugarcane		Size (ha)
Sunflower		Size (ha)
Wheat		Size (ha)
Other		Specify

Horticulture
Herbs		Specify		Size (ha)
Vegetables		Specify		Size (ha)
Flowers		Specify		Size (ha)

Livestock
Cattle		Number
Dairy		Number
Goats		Number
Sheep		Number
Other		Specify		Number

Poultry
Description		Number

Piggery
Description		Number

Fruits and Nuts
Description		Ha

Cotton & Lucerne
Type		Ha

Bees
Description		Number

Game
Description		Number

Other :
Description		Number

E: ESTIMATED ANNUAL TURNOVER FROM FARMING OPERATIONS

* Please tick in appropriate box

< R 50 000 /annum

R 50 000 - R 100 000 /annum

R 100 000 - R 500 000 /annum

> R 500 000 / annum

F: ANNUAL MEMBERSHIP FEES

Communal or Commonage Land Annual Membership	R 300.00
Own or Leased Land Annual Membership	R 1 500.00
Commercial	R 10 000.00
Commodity Annual Membership	R 375 000.00

G: PAYMENT INFORMATION & BANKING DETAILS

Name of Account	AFASA NW	Branch	Mafikeng
Bank	Standard Bank	Branch code	051001
Account Number	300508816	Deposit Reference	YOUR CELL NUMBER

IMPORTANT: Please don’t forget to write a reference on your deposit slip, as it will not be possible to allocate payment with no reference.

H: SIGNATURE & DATE

Signature
Date

Submit Application

• Please email this application form together with proof of payment to: info@nwafasa.org or WhatsApp to: 079 515 7140
• Please submit the original to your District Chairman / Secretary, with proof of payment: See contacts on Website nwafasa.org

I: NWAFASA OFFICE CONTACT DETAILS

North West Afasa
P.O Box 1404
Zeerust
2865

Ms Mosidi Morule : +27 (79) 515 7140 (SECRETARY)
Mr Andrew Aphane: +27 (83) 557 6605
msdrmrl9@gmail.com / andrew@aphamo.co.za
Email: info@nwafasa.org
Website: nwafasa.org

MEMBERSHIP BENEFITS

• As a member of NWAFASA you will be entitled to vote, elect and be elected as leader of the association
• As a member of NWAFASA you will participate in influencing government policy in favor of the farming industry
• As a member of NWAFASA you will participate in any of its structures e.g. NWAFASA Commodity Chamber, NWAFASA Co-Operative Chamber, NWAFASA Youth, NWAFASA Women’s League etc.
• As a member of NWAFASA you will benefit from its programs which are aimed at providing access to Technical Support & Training; Agricultural Finance Support and advice, Markets and Agri BEE initiatives
• In addition, you will benefit from dedicated loyalty programs that are exclusive to members only
• As a member of NWAFASA you will receive a member’s certificate valid for 12 months

Protection of Personal Information Act, 2013 (POPIA)

We are committed to ensuring the security and protection of the personal information that we process, and to provide a compliant and consistent approach to data protection. As a Data Subject you do have certain rights, including the right to be notified that personal information about you is being collected. A copy of our POPIA Section 18 Privacy Notification – Members is available at our Information Officer or on our website.