Submit completed forms to:

PO Box 4464
Cape Town, 8000, RSA
Tel. +27 (0)21 509 5242
Fax. +27 (0)21 509 0160
www.actuarialsociety.org.za

Actuarial Society of South Africa

c/o Old Mutual Office 2
2nd Floor West End Mall
Jan Smuts Drive, Pinelands
7405

Application For Membership

*Please note that details marked with an asterisk are mandatory for all members.

Personal Details Applicant (Please PRINT in BLOCK CAPITALS using black ink)
*Title (Circle)

Mr / Miss / Ms / Mrs / Dr

Other (Please Specify)

*First Names (in full)

"Applicant"
*Surname
*ID Number
For Non-SA applicants
Passport Number
*Date of Birth

Nationality
Gender

Male / Female

Black / Coloured / Oriental / White /

Indian

Race

Contact Details
*Postal Address:

Tel. Mobile
Tel. Work
Tel. Home
Fax. Work

*Postal Code

Fax. Home
*Email

Residential Address:

Business Address:

*Postal Code

*Postal Code

Membership details
Applying for Membership as:

Affiliate

Library

Fellow

Associate

Are you currently a member of the Actuarial Society of South Africa?

Student

Staff

Yes

No

Yes

No

Yes

No

If so, please provide your Member Number:

Are you currently a member of another Actuarial Society / Faculty / Institute?
If so, please specify which and provide your Actuarial Reference Number:
Have you ever been refused membership of this or any other Professional Body?
If so, please provide particulars on a separate page.

Employment Details
Employment Sector:

Life / Pensions / Investments / Short-Term Ins / Health / Banking / Currently Unemployed

Other (Please Specify)

Employer

Qualifications / Degrees obtained

Qualification

Institution

Year

Qualification

Institution

Year

Actuarial Society of South Africa Role(s)

Current participation in any of the structures or activities of the Actuarial Society of South Africa:
Body

Role

Body

Role

Declaration by Applicant:
By signing this declaration, I confirm and agree that, to the extent allowed by law:
I am familiar with the constitution, bye-laws, guidance on professional conduct and the privacy policy issued by the Actuarial Society

(all these documents can be obtained from the Actuarial Society), and understand that I am obliged to remain familiar with these
documents;

by submitting this application, I am bound by the disciplinary procedure and guidance on professional conduct issued by the
Actuarial Society from time to time;

I hereby authorize the Actuarial Society to obtain information on my disciplinary record from the organisation referred to above.

I expressly accept the privacy provisions included in the privacy policy of the Actuarial Society and the terms of the privacy policy are
expressly incorporated herein by reference; and
I expressly consent to allow the Actuarial Society to collect, receive, record, organize, collate, store, update, modify, retrieve, alter,
consult, sue, disseminate, disclose and process personal information as provided for in the privacy policy.

no disciplinary investigations are pending against me and if there are, I have provided sufficient details thereof in a document
attached to this application;

This declaration constitutes acknowledgments of fact by the Applicant. The Application must read the declaration carefully and
ensure that each statement is true and correct as this will limit the rights of the Applicant to claim that these statements are not true
and correct. The Actuarial Society may also have claims and other rights against the Applicant if any statement is not true and
correct.
I have read and accept the privacy policy of the Actuarial Society. (please tick box)
Applicants Signature:

Date:

Recommendation and declaration by two Referees:

(N.B. For applications for Student Membership one of the referees should be the approved actuarial academic from the applicants university
where such a person exists.)
(to be completed by a Fellow member of
the Actuarial Society)

(to be completed by a Fellow / other

professional / university academic)

Name (please PRINT)

Professional Body (or Academic Post)
Relationship to Applicant
Address

Declaration:
By signing this declaration, I confirm and agree that, to the extent allowed by law, I have known the applicant for at least one year and, to the
best of my knowledge and belief, consider him/her to be a fit and proper person to be a member of the Actuarial Society of South Africa.
This declaration constitutes acknowledgments of fact by the Referee. The Referee must read the declaration carefully and ensure
that each statement is true and correct as this will limit the rights of the Referee to claim that these statements are not true and
correct. The Actuarial Society may also have claims and other rights against the Referee if any statement is not true and correct.
Date
Signature of Referee

Approved by Council

Date

Documents to be attached:

Certified Copy of South African Identity document

For foreign students, certified copy of passport
If you are concurrently applying for membership of another Actuarial body, or if you have already been accepted or refused
membership of another Actuarial body, full details must be attached to this Application Form.
If you have previously been a member of the Actuarial Society of South Africa and wish to reactivate your membership, you must
provide proof of your full academic record.
If you are applying for Fellow/Associate membership on the basis of Mutual Recognition of a qualification obtained through another
actuarial body please contact the Administrative Office of the Actuarial Society for further information.

Additional Information To Be Completed For Student Membership

The Admissions Committee, on behalf of Council, will at its discretion normally admit as a student member an applicant who has achieved the
academic requirements as set out on the Societys website subject to satisfactory conduct.

Please PRINT all details clearly (or CIRCLE the correct option where applicable) in BLACK ink.

Do you comply with the Student Admission Requirements as set out on the Societys website?

Yes

No

Academic Information

High School Information

Last High School attended

Year Completed

Examining Body

Country

University Information
University 1

Years Attended

University 2

Years Attended

University 3

Years Attended

Qualifications Obtained
List the various Actuarial Science / Mathematical Subjects completed at university (together with marks obtained):
Mathematics

Mathematical Statistics

Actuarial Science

What is the highest university qualification you have obtained?

None / Bachelors / Honours / Masters / Ph.D.

What is the highest university actuarial science qualification you have obtained?

None / Bachelors / Hons / Higher

List the examinations of the Actuarial Society from which you have been recommended for exemption:

Documents to be attached:

Original Official University Academic Record(s) (i.e. not simply a printout from a website)
Certified copy of school-leaving certificate