The Insurance Institute of South Africa NPC
Association incorporated under Section 21
Reg No: 1993/002172/08
Physical Address: Victoria Gate South, Hyde Park Lane Manor
cnr Jan Smuts & Hyde Lane, Hyde Park 2196
Postal Address: PO Box 413264 Craighall 2040
Tel: 0861 00 4472 / Fax: 0861 01 4472 or +27(0) 11 325 0606
E-mail: info@iisa.co.za / Web: www.iisa.co.za
Study Material Order Form
DID YOU KNOW?
2015 IISA Programmes in Insurance offered through UNISA
Centre for Business Management and other UNISA
Programmes
Upon completion of Unisa CBM’s Introductory Programme
in Insurance, Programme in Short Term Insurance/Life
Insurance/Retirement Fund Management, Programme in
Advanced Insurance Practice or Programme in
Risk Management, you may be eligible
for IISA Professional Membership.
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Please complete this form in block letters with a black pen.
•
Where appropriate, insert a
•
No material will be produced or released without proof of payment into IISA’s account.
•
Study material orders do not include examination registration. To register refer to www.unisa.ac.za/insurance.
or in the relevant box or indicate quantity required.
Contact the IISA for more information.
Assignments will be sent to you directly from UNISA and not with your study material.
Section A
Title (Mr/Dr/Mrs):
Personal Details
First Names:
Surname:
ID Number:
Alternate ID type:
Gender:
□ N/A □ SA Passport
□ Male □ Female
□ Non-SA Identity Document
Equity: □ Black
□ Other
□ Indian
□ Coloured □ White
Nationality (e.g. South African, Zimbabwean):
Highest Qualification:
□ None □ Physical □ Vision □ Hearing □ Other
□ B. Degree □ Masters □ Doctorate □ Other
Disabilities:
Home Language:
□ None
□ Matric
□ Diploma
Employer:
Postal Address:
Code:
Physical Address:
Code:
Tel (work):
Cellular:
Work Email:
Private
E-mail:
Section B
Order Details: IISA Programmes in Insurance
NB: Please check subject codes and names carefully.
IISA does not accept responsibility for incorrect books ordered. Visit www.iisa.co.za for the 2015 Unisa CBM Subject List.
Language:
All study material is only available in English
Format:
B = Book C = CD (PDF Read Only, not audio, not printable, cannot copy) B+C = Book and CD (Combo)
Qty
B
Format
C
B+C
Subject Code
Programme/Subject Name
Continued overleaf
Section C
Distribution Details & Prices
Postage Fees – National (South Africa only): Post material to my Postal Address as specified on Section A at:
1 X Book = R30.00
2 X Books = R30.00
3 X Books = R50.00
4 X Books = R50.00
5 X Books = R50.00
R30.00 per parcel for 1 to 5 CDs posted
(Depending on the speed of the SA Post Office please note it could take 1-2 weeks to receive your parcel.)
Post – International (non-SA): Post material to my Postal Address as specified on Section A at:
1 to 5 Books = R350.00 per parcel
1 to 5 CDs = R170.00 per parcel
Courier Fees– National (South Africa only): Courier material to my Physical Address, as specified on Section A at:
Johannesburg
– R100.00 per parcel (1 to 5 Books or CDs)
Pretoria
– R120.00 per parcel (1 to 5 Books or CDs)
Rest of South Africa – R160.00 per parcel (1 to 5 Books or CDs)
Courier Fees– International (non-SA): Courier material to my Physical Address, as specified on Section A at:
R450.00 per parcel (1 to 5 Books or CDs) to the following Countries: Botswana, Namibia, Zimbabwe, Lesotho, Mozambique,
Swaziland, Mauritius (Countries not listed here please contact IISA for a quote)
Collect: I will collect the material from the IISA office - 1st Floor, Victoria Gate South, Hyde Park Lane Manor, cnr Jan Smuts Avenue
And Hyde Lane, Hyde Park, 2196, Johannesburg
Own Couriers: I will send my own courier company to collect my material from the IISA office - 1st Floor, Victoria Gate South,
Hyde Park Lane Manor, cnr Jan Smuts Avenue and Hyde Lane, Hyde Park, 2196, Johannesburg, South Africa.
Section D
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•
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Payment Details & Declaration
For book module prices, refer to Unisa CBM Subject List, available from www.iisa.co.za
No material will be produced or released without proof of payment into the correct bank account
NO CASH payments will be accepted at the IISA office
Study Material (www.iisa.co.za):
Book
Qty ………… x R…….……....…
=
CD (Read only)
Qty ………… x R…….…………
=
Combo - Book & CD
Qty ………… x R………..…...…
=
=
Postage/Courier Fees (refer Section C )
Bank Forex Levy** (outside of South Africa only) – R150.00
** per order under R10 000
=
R150.00
TOTAL:
=
0
R ……………… 0
R ……………… 0
R ……………… 0
R ……………… 0
R ……………… 0
R ………………
I enclose a cheque/bank draft made payable to Insurance Institute of South Africa (NO CASH accepted at IISA office)
I enclose proof of direct deposit. NB: Please use Name & Surname as deposit reference
Banking Details:
Account Name: Insurance Institute of South Africa
Bank: First National Bank, Hyde Park
Branch Code: 255805
Account Type: Current
Account No: 6212 2481 641
SWIFT Code (for international payments only): FIRNZAJJ
Please debit my credit card:
Visa
Master
Diners
Amex
Credit Card number:
Name on Card:
Expiry Date:
Payment Option:
m
m
y
Straight
y
CVC Code (Last 3 number on reverse side of card): ____
Budget: ….…. Months
Declaration
I understand that the Insurance Institute of South Africa does not refund or substitute any fees paid for Study Materials and will not accept
responsibility if incorrect material is ordered. I, further, undertake to protect the copyright of the IISA and under no circumstances to make the
study material available for use by another person, or to copy the material or allow the material to be copied and/or made available in any form or
media, whatsoever.
□ Yes □ No
Would you like to receive information regarding IISA market activities and educational matters?
Signature:
...........................................................................................
Date:
…....…… / ……....… / 20….....……
Please send ORDER FORM plus PROOF OF PAYMENT to:
Local fax: 0861 01 4472 or 011 325 0606 International fax: +27(0)11 325 0606
or E-mail: info@iisa.co.za