Alumni Association Form

Information Update

Please note the following:

For Information Update complete from number 1 to 4.
For Alumni Association Membership complete from number 1 to 8

1. Biographical Information

Title:

First names:

Surname:

Maiden name:

Student no:

SA ID No:

Date of Birth:

Passport No:

Postal Address:

Residential Address:

Country:

Province:

Tel no:

Fax no:

Cell no:

Email address:

2. Would you like to recieve communication from Unisa?

Yes No

3. Unisa Qualification

Qualification (e.g Certificate, Degree)

College/School (Economic and Management Sciences)

Year Completed

4. Employment Details

Employed

Self Employed

Unemployed

4. Employment Details

Employer Name:

Sector:

Position:

Address:

5. Membership Fee (Minimum amount of R150 p.a.)
(Will be automatically renewed)

How much do you pledge to donate per month / per annum:

6. Stop Order: (For Unisa staff members only)

Please provide the following information:

Personnel Number:

I authorise Unisa Finance Department to debit/deduct money as specified above (see 5 – membership fee) from my account/salary (Unisa staff members) for payment of Alumni Association Membership. (Complete your name and surname on the box provided)

I authorise Unisa Finance Department to debit/deduct an amount of R

7. Payment Method

Debit Order (Action Date 15th)

Debit Order (Action Date 30th)

Other:

Please provide your Banking Details:

Bank:

Branch Code / Name:

Account No:

Type of Account:

8. Direct deposit or EFT payments, use the following account details:

Bank: First National Bank

Name of account: Unisa Foundation

Type of Account: Public Sector Cheque Account

Account number: 62799629062

Branch name: Sunny Park

Branch code: 250645

Swift Code (International Donors) : FIRNZAJJ

NB: Please code your reference as AA/Your ID Number e.g. AA/7201255405086

For international donors: Please code your reference as AA/Student Number

Consent form in terms of the Protection of Personal Information Act NO 4 of 2013

I declare that all the particulars furnished by me on this form are true and correct. I undertake to comply with all the rules, regulations and decisions of the university. I, as an alumnus of the university, hereby consent that Unisa may collect, use, distribute, process and communicate my personal information for all required alumni processes pertaining to my membership of the Unisa Alumni Association, which may include, but is not limited to, internal administrative processing, institutional and scholarly research, and third parties rendering database management facility on behalf of the university. I understand that in terms of POPI and other laws of the country, there are instances where my express consent is not necessary in order to permit the processing of personal information, which may be related to investigations, litigation or when personal information is publicly available. I will not hold the university responsible for any improper or unauthorised use of personal information that is beyond its reasonable control. I confirm that I have read the notice and understand the contents thereof.