Create online member application form Please fill in your personal information below. Please make sure you complete the information in sentence case. Eg: Joe Soap. Title: *Mr.Mrs.Ms.Miss.Mnr.Mev.Mej.Dr.Prof. Full Names: * First Name: * Middle Name: Surname: * Initials: Maiden Name: Gender: * Male Female Marital Status:– None –SingleMarriedDivorcedWidowed Identity Number: * Date of Birth: * Year: *1917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001 Month: *JanFebMarAprMayJunJulAugSepOctNovDec Day: *12345678910111213141516171819202122232425262728293031 Are you a South African Citizen?: * Yes No If No, specify: * Nationality: *South AfricanNamibiaZimbabweZambiaTanzaniaSwazilandBotswanaMauritiusMalawiLesothoMozambiqueAngolaRest of AfricaAsian CountriesAustraliaNew ZealandCentral and South AmericanOther an Rest of OceanNorth American CountriesZaireSeychellesEuropean CountriesSADC except SAN/A: InstitutionForeignUnspecified Employment Equity Profile: *AfricanColouredIndianWhiteAsianOther Specify: * Do you have a disability as contemplated by the Employment Equity Act 55 of 1998?: * Yes No If Yes, specify: *Sight (even with glasses)Hearing (even with hearing aid)Communication (talking, listening)Physical (moving, standing, grasping)EmotionalMultipleDisabled but unspecifiedIntellectualUnknown disability status Access to Information: * I wish to allow for my name and contact details as member of the Institute to be readily available to the general public I wish to restrict access to my name and contact details to the staff of SAIPA only Application Date: Format: 20.01.2017 Contact Details Please complete your contact details below. Only the Cellphone field is required, however, we do request that you provide alternate contact numbers as well. Remember to complete your phone number, without the leading 0, and without any spaces. Email: * Cellular: *+27 Tel. Work:+27 Fax Work:+27 Tel. Home:+27 Physical Address Line 1: * Line 2: * Line 3: City / Postal Code: Country: * Postal Address Line 1: * Remember to include “PO Box” if this is not a street postal address. Line 2: Line 3: City / Postal Code: * Country: * Language Preferences Language: * English Afrikaans SeTswana isiZulu SePedi isiXhosa SisWati xiTsonga thsiVenda Sotho isiNdebele Other Employment Details Employer/Firm: Firm Address: Employed Since: Year:196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Month:JanFebMarAprMayJunJulAugSepOctNovDec Day:12345678910111213141516171819202122232425262728293031 VAT Registration Number: If you do not have your companies VAT number, you may leave this field blank. Industry Sector: *Agriculture, Fishing & ForestryAutomotiveBankingBuilding & ConstructionChemical IndustryDevelopmentDistributionEducationElectrical PowerEngineeringEquipmentFinancial Services and AccountingFood & BeveragesFranchisingFurniture & ApplianceGovernmentHealth & WelfareInformation & Communication TechnologyInsuranceManufacturingMining & MineralsMunicipalNon-Profit OrganizationsOil & GasProfessional ServicesPublic SectorReal EstateSecurityTextiles & ClothingTransport & StorageTravel, Tourism & RecreationalWaste, Pollution & RecyclingWholesale & Retail Specialist Fields: *AuditingCommercial LawFInancial AuditingCorporate GovernanceTaxOther Position Held: Nature of Duties: Qualifications: *3 years4 years5 yearsMore Living Standards Measurement: *R 120 000 and belowR 121 000 – R 240 000R 241 000 – R 360 000R 361 000 – R 480 000R 481 000 – R 600 000R 601 000 – R 720 000R 721 000 and above Salary Brackets of the members per annum Practical Experience Academic Profile Membership of other professional bodies Have you ever applied for membership of any other professional bodies?: *YesNo If so, which?: With what result?: Membership Number: Are you still a member of such a body?:– None –YesNo If No, under what circumstances did you cease to be so?: Terms And Conditions Applications will only be processed on full receipt of the required documentation uploaded or mailed to SAIPA which are: Certified Copy of Identity Document Certified Copy of Degree and Academic Record from University, stating subjects passed (only official record accepted – not those downloaded from the Internet) Proof of completion of SAIPA Learnership (if applicable) OR Proof of completion of other Professional Body Learnership (only those recognised by SAIPA will be considered) OR Proof of 6 year’s verifiable experience, to be set out on your company’s letterhead SAIPA reserves the right to require hard copies of any electronically uploaded documents and to reject application should the applicant not have met the minimum requirements of SAIPA membership, as stipulated from time to time. The RPL Committee reserves the right to request the applicant to complete the Professional Evaluation process should it be deemed necessary. I, the undersigned wish to apply for membership in order for me to qualify as a full member of SAIPA. : * I agree that I have read and understood the abovementioned terms and conditions as well as the SAIPA Code of Conduct, Constitution and Bylaws, and I am fully aware of my expected conduct should I qualify as a full member of the South African Institute of Professional Accountants (SAIPA). I am further aware that SAIPA has a stringent disciplinary process should my conduct be against the SAIPA Code of Conduct. Please note: Applications take 6 weeks from receipt to process. 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