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    Samro (1).pdf

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    47 views13 pages

    Samro PDF

    Uploaded by

    Jazz

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 13
    Please Note: Application for membership is free. =! INSTRUCTIONS, 4. PLEASE USE BLOCK LETTERS AND A BLACK PEN TO COMPLETE. SAMRO- COMPOSER |, AUTHOR APPLICATION FOR SAMRO MEMBERSHIP. 2. PLEASE ATTACH A COPY OF YOUR ID / PASSPORT TO THE COMPLETED APPLICATION. A. PERSONAL DETAILS Title Tot Ms Mrs Dr Prof Rev Surname HENDRICKS Full Name(s) Seueen PicecH A.K.A / Psoudonym CHEEZ66L FUEKK ID | Passport Number oe 4|2 |o|s ale|i [3 fo fo fs ju Se Date of Birth (YYYY-MM-DD) [| Ja [zJe lsh Ja] Residential Address. 668 VINCENT & ET, MORELETAP RIC Postal Address 66% NINCenmT STREET, MoeELETACRre I Country of Bit Ssetn Ceeice Nationality | out Chee1 can | Gender Male Female A Contact Details | Tel (HAW) | Cell / Mobile B1z, O1S 8304 CHENSRIcr SOTUES. co -2 E-mail Address | eae B. CONTACTS / NEXT OF KIN wir we Me Dr Full Name(s) and Surname(s) Evecme Henoeicre = Tel: O14 303 SIAS e-mail Address Nir Mis Mrs Or ON Prof Rev Full Name(s) and Surname(s) EVETON fHameaytT Tel: O84 CBO ZATS | | e-mail Address: eee wr Ms Mrs Or Prof Rev Full Name(s) and Surname(s) Tel: e-mail Address: aP C. BANKING DETAILS Bank Name Capitec Full Names and Surname of Account Holder HLENGANT MALULEKA Account Number 1370608514 Account Type Cheque Mzansi_ | Transmission Other Branch Name i ‘Branch Code _ aE DECLARATION Ihereby apply to be admitted as a member of SAMRO in terms of its Memorandum of Incorporation ("the MOI"). If admitted, | agree to abide by the terms of the MOI as well as SAMRO’s Rules and Regulations. | also hereby declare that | am not a member of any Performing Rights organisation or society in any other country, or SAMRO territory and that the details contained in this Application Form are correct. Signed at Prete rig Onthis day of 4t4 Ape 2014 Applicant's Signature EC (The form must be signed by your parent / guardian if you are under 18 years of age). Return completed form to: SAMRO Writer Services Department P.O. Box 31609, Braamfontein, 2017. ae

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