P O Box 20034
WILLOWS
9320
TEL: 051 448 0318
FAX: 051 448 0920
E-MAIL: santagertrudis@telkomsa.net
APPLICATION FOR MEMBERSHIP
(Personal Information)
1.
TYPE OF MEMBERSHIP FOR WHICH APPLICATION IS MADE
(INDICATE THE APPLICABLE ITEM WITH A )
INDIVIDUAL MEMBER

PARTNERSHIP

COMPANY

TRUST

2.
TITLE: (State Prof, Dr, Mr, Miss, Mrs, ect.) __________________________
3.
INITIALS: ______________________________NAME ________________SPOUSE_______________
4.
SURNAME: ____________________________________4.1 ID NO. ___________________________________
5.
MEMBERSHIP NAME
(if not an individual) ______________________________________________________________
6.
REGISTRATION NO: ____________________________________________
7.
VAT NO: ___________________________
8.
LANGUAGE IN WHICH CORRESPONDENCE IS REQUIRED:
9.
ADDRESS OF APPLICANT:
POSTAL CODE:
AFRIKAANS

ENGLISH

____________________________________________
____________________________
____________________________
__________
10. TEL: _______________________(W) _____________________ (H) CELL: _______________________
FAX: ________________________________
E-MAIL: _______________________________________
Y Y
M M
D D
11. MEMBERSHIP REQUIRED AS FROM:
12. MY CHOICE FOR HERD DESIGNATION MARKS ARE:
(Please give 4 combinations in order of preference - not more than 3 letter)
13. MY CHOICE FOR A HERD NAME: (Town and city names are not allowed)
(Please supply four (4) combinations in order of preference - not more than 18 letters. PRINT-HAND please)
(a) __________________________________________
(b) __________________________________________
(c) __________________________________________
(d) __________________________________________
-214. ARE YOU CURRENTLY OR WERE YOU A MEMBER OF ANY BREEDER SOCIETY IN ASPECT OF
THE SAME OR DIFFERENT BREED?

YES

NO
IF YES, GIVE THE SOCIETY'S NAME AND YOUR MEMBERSHIP NUMBER IF AVAILABLE:
NAME OF SOCIETY: _____________________________________________________________
MEMBERSHIP NUMBER: _________________________
ARE YOU CURRENTLY OR WERE YOU A MEMBER OF ANY PERFORMANCETESTINGSCHEME?
YES

NO

IF YES, GIVE THE NAME OF THE SCHEME AS WELL AS YOU MEMBERSHIP NUMBER, IF
AVAILABLE:
SCHEME: ________________________________________________________________________
MEMBERSHIP NUMBER: __________________________
15. FARM NAME: _________________________________________
16. TOWN / CITY NEAREST TO YOUR FARM: _______________________________________
ANIMAL-, SEX INDICATOR SEQUENCE NUMBERS WITHIN HERD WILL BE UTILIZED AS
FOLLOWS:

BOTH SEXES UTILIZE ONE SET OF SEQUENCE NUMBERS
SEQUENCE NUMBERS MUST BE RESET TO ONE AT CHANGE OF YEAR.
YES

SIGNED AT ____________________________ ON THIS _______ DAY OF ____________________ 20 ____.
_____________________________
SIGNATURE
-3-
P O Box 20034
WILLOWS
9320
TEL: 051 448 0318
FAX: 051 448 0920
E-MAIL: santagertrudis@telkomsa.net
I, the undersigned, agree to be bound by die Constitution and the rules, regulations and bye-laws of the
society.
Attached (page 5) find a list of all Stud animals currently in my possession.
A cheque \ postal order (delete which is not applicable) to the amount of R___________ in payment of the
following, is attached hereto:
Bank details: STANDARD BANK, Acc: 041209850, Branch Brandwag - 055534
MEMBERSHIP FEE (per year)
R440,00
(From January to December)
REGISTRATION OF HERD NAME
R110,00
(ones off)
ADVERTISING FEE (per year)
R300,00
SUB TOTAL
R850,00
VAT
R119,00
TOTAL
R969,00
(No per capita of transfer fees will be invoice until the end of the financial year. Per capita fees is charge only
for animals older than 12 months)
SIGNED AT ________________________ ON THIS _____ DAY OF ___________________ 20____.
____________________________
SIGNATURE OF APPLICANT
-4-
LIST OF PEDIGREE ANIMALS IN YOUR POSSESSOIN:
LYS VAN GEREGISTREERDE DIERE IN U BESIT:
Registrasienommer
Registrasion number
Identifikasie
Identification
Geslag
Sex
Beskrywing
Description
-5-
P O Box 20034
WILLOWS
9320
TEL: 051 448 0318
FAX: 051 448 0920
E-MAIL: santagertrudis@telkomsa.net
PARTNERSHIPS
NB:
IN THE EVENT OF A PARTNERSHIP, ONE OF THESE DOCUMENTS MUST BE
COMPLETED FOR EACH PARTNER IN THE PARTNERSHIP AND THESE DOCUMENTS
MUST ACCOMPANY THE APPLICATION FOR MEMBERSHIP.
FOR OFFICE USE ONLY
1.
DOCUMENT CODE 1511
2. PARTNER NUMBER _____________________________
I, We
3.
INITIALS (If applicable): _________________________
4.
SURNAME: ____________________________________
5.
FOR OFFICE USE
6.
TITLE (State Prof, Dr, Mr, Miss, Mrs, ect.): _______________________________
FOR OFFICE USE
ADDRESS:
__________________________________________________
____________________________________
____________________________________
POSTAL CODE: _________________
THAT APPLIED FOR MEMBERSHIP UNDER THE MEMBERSHIP NAME:
FOR OFFICE USE ________________
DO HEREBY AGREE AND ARE BOUNDED TO BE HELD JOINTLY AND SEPARATELY RESPONSIBLE FOR
PAYMENT FO ANY MONEY AND PAYABLE TO THIS ASSOCIATION AS MAY BE PAYABLE FROM TIME TO
TIME.
SIGNED AT __________________________ THIS ________ DAY OF _______________________ 20 _____.
__________________________
SIGNATURE OF PARTNER
-6-
P O Box 20034
WILLOWS
9320
TEL: 051 448 0318
FAX: 051 448 0920
E-MAIL: santagertrudis@telkomsa.net
PADBESKRYWING
ROUTE DESCRIPTION
LET WEL:
Hierdie padbeskrywing moet deur alle lede voltooi word. Verstrek asseblief in duidelike skets
waarop die pad na die plaas (plek van inspeksie) in kilometers aangedui word.
NB:
This route description must be completed by all members. Please supply a distinct sketch
outlining the direction to the farm (place of inspection) in kilometers.
NAAM / NAME _____________________________________________________________________________
PLAAS ADRES / FARM ADDRESS ___________________________________________________________
TEL: PLAAS / FARM _______________________ BESIGHEID / BUSINESS ______________________
AFSTAND (KM) VAN NAASTE DORP / DISTANCE FROM NEAREST TOWN: _____________________
PADBESKRYWING / ROUTE DESCRIPTION
-7-
P O Box 20034
WILLOWS
9320
TEL: 051 448 0318
FAX: 051 448 0920
E-MAIL: santagertrudis@telkomsa.net
FEES EFFECTIVE FROM 2 JANUARY 2010
ENTRANCE FEE
NO FEE
ANNUAL SUBSCRIPTION FEES
R 440,00
REGISTRATION OF HERD NAME
R 110,00
PER CAPITA: (per year)
Females: App. A
App. B & SP (Males & Females)
Minimum fee (Less than 25 animals)
Maximum fee (More than 700 animals)
R
22,00 per animal
R
53,00 per animal
R 1100,00 plus membership fee
R38192,00
TRANSFER FEES
NO FEE
INSPECTIONS:
NO FEE
Inspections & Classification fees
App A
App B and Stud Book Proper
Special inspection (on request)
NO FEE
NO FEE
NO FEE
R 950,00 plus R3,00 per kilo
(can change AA tariffs are use)
REGISTRATION OF ANIMALS FEE:
NO FEE
DUPLICATE CERTIFICATES
R 5,00 per certificate
RE-INSTATEMENTS
RE-INSPECTION
RE-INSTATEMENT OF MEMBERSHIP
R100,00 per animal per year cancelled
R100,00 per animal
R1000,00
PENALTY ON LATE TRANSFERS
R 50,00 per animal
PENALTY ON LATE BIRTHNOTIFICATIONS
0-60 days
61-90 days
91-120 days
121 - 150 days
151 - 180 days
181 - 270 days
271 days plus
Only for members resident in the republic of South Africa:
FREE OF CHARGE
R10,00 per animal
R15,00 per animal
R20,00 per animal
R40,00 per animal
R80,00 per animal
R80,00 plus DNA tests to be done for parentage
control
14% VAT will be added to all fees.