Labour Relations Act, 1995 (Act No. 66 of 1995)

Notices

Motor Industry Bargaining Council (MIBCO)

Motor Industry Sick, Accident and Maternity Pay Fund Rules, 2019

Annexures

Annexure B: Application for Membership
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ANNEXURE “B”

 

MOTOR INDUSTRY SICK, ACCIDENT AND MATERNITY PAY FUND

( ________________________Region)

 

APPLICATION FOR MEMBERSHIP

 

I, (full name in block letters)______________________________________________________

 

____________________________________________________________________________

 

a member of the Motor Industry Staff Association, Membership No______________________

employed by:

 

Employer’s Name______________________________________________________________

 

Address_____________________________________________________________________

 

____________________________________________________________________________

and residing at (applicant’s private address)

 

____________________________________________________________________________

 

____________________________________________________________________________

 

my date of birth being ___________(day)________________(month)____________(year), my

 

Identity number being __________________________________________________________

 

and occupation ___________________________________ hereby apply to be registered as a

member of the Motor Industry Sick, Accident and Maternity Pay Fund.

 

I agree to abide by the provisions of the rules of the Fund.

 

Answer “Yes” or “No” to the following questions, and if the answer is “Yes” then give full details:

 

(1) Do you suffer, or have you at any time suffered from any deformity, infirmity, maiming, physical defect, chronic disease, or from any illness? Yes / No

If yes details____________________________________________________________

 

______________________________________________________________________

 

(2) Have you at any time previously contributed to this Fund in this or any other Region? Yes / No

If yes details______________________________________________________

 

________________________________________________________________

 

I solemnly and sincerely declare that all the particulars given by me in this form are, to the best of my knowledge and belief, true and correct and I am free from disease or infirmity of a chronic nature except as specified above.

 

 

DATED THIS ______________DAY OF _______________________________20_____

 

 

(SIGNED)__________________________________________

 

oo00oo

 

 

FOR OFFICE USE ONLY

 

Date received ________________________ Date registered _____________________

 

Council number _________________________________