CONTRACTORS REGISTRATION FORM

CONFIDENTIAL INFORMATION

FIRST ENROLMENT REF: SEC 21/ ____________________________________________________________

ANNUAL RENEWAL REF: SEC 22/ ____________________________________________________________
ANNUAL RENEWAL REF: SEC 23/ ____________________________________________________________
ANNUAL RENEWAL REF: SEC 24/ ____________________________________________________________

Company Name

Full names

Surname

ID No.

Cellphone No.

Job Designation

Vehicle Make/Model

Vehicle Colour

Vehicle Reg

ID copy attached

Card Issued

Email address (for billing):

I agree to the once-o cost of this initial registration the cost being: R50.00 per electronic registration.
Plus an additional R50.00 if a card is required. (A card will only be issued if there are no ngerprints).
Annual renewal fees are R50.00 billed in January of each year.

I con rm that the above information is, to the best of my knowledge, true and correct.

CONTRACTORS: ____________________________________________________________________________

DATE CAPTURED: ____________________________________________________________________________

Admin O ce: 033 032 0588 | Security Control: 033 001 9291
Email: admino ce@stjohnsvillage.co.za | www.stjohnsvillage.co.za
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