I/We apply to be admitted as a member of the South African Business Coalition on HIV/AIDS. I declare that I have the authority to act on behalf of and to bind the applicant, and that, if admitted as a member; the applicant will be bound by the Constitution, Rules and Regulations of SABCOHA in operation during the term of membership.

State whether a:

Company/Close Corporation Registration No:

Date business established/company or close corporation registered:

Trade name (If different from the above):

Street address:

Code

Postal Address:

Code

Telephone No:

FAX No:

Cell Number:

Name of business applying for membership

E-Mail Address:

Website:

Name and contact details of CEO, Managing Director or whichever is applicable:

Main contact person & position:

Name of branches and/or wholly owned subsidiary companies to be included under this membership:

Please describe briefly, the main activity/activities of the business:

Total number of employees (include staff of all companies and branches to be covered by membership)

How were you introduced to SABCOHA?

Sponsorship Options – per annum

Sponsor Category

Amount
(excl. VAT)

Amount
(incl. VAT)

Platinum (R200,000 and above)

Gold ( R100,000 – R199,999)

Silver ( R50,000 – R99,999)

Bronze ( R10,001 – R49,999)

Membership Category

Entry Level Corporate (R10,000)

Small and Micro Enterprises (R1,000)

Method of payment:

Electronic Bank Transfer

Cheque
this option only applies with hand delivery

Cash

SABCOHA banking details:

Bank: Standard Bank
Branch: Rosebank
Branch Code: 004305
Account Number: 002006189
Account Name: SABCOHA
Account Type: Current Account
Reference: SABCOHA Invoice No. & Your Company Name

Can we include your organization in our Newsletter distribution ?

Yes

No

In which Provinces do you have business operations ?

Name of authorized signatory:

Position held:

Terms of Membership

• Membership means renewable annual financial contributions for the collective effort and achievement of organizational objectives. Members can formally participate in organizational structures and influence the organizational priorities. VAT is applicable to membership.


• As a Public Benefit Organization SABCOHA has been approved for purposes of Section 18A(1)(a) of the Income Tax Act and donations to the organization will be tax deductible in the hands of the donors.


• Membership is effective from the moment we receive a completed membership application form together with proof of payment of the fees.


• Membership fees are renewable annually. SABCOHA's financial year runs from March to February.


• Termination of membership to be communicated in writing, six months prior to the end of SABCOHA's financial year-end.

VAT No: