DORMER SKAAPTELERSGENOOTSKAP/
DORMER SHEEP BREEDERS’ SOCIETY OF S A
POSBUS/BOX 506/
TEL:051-4302455/FAKS:051-4484220
E-POS/E-MAIL:dormer@studbook.co.za
APPLICATION FOR PARTICIPATION
AANSOEK
PARTICIPANT / DEELNEMER
(The Participant is the owner of the animals / Die Deelnemer is die
eienaar van die diere) Breed/Ras : _DORMER_____________________
__________________________________________________________________________________________________
I/WE -
EK/ONS,
1. TITLE (indicate
PROF., DR., MR., MRS., MISS., etc.)
TITEL (meld
PROF., DR., MNR., MEV., MEJ., ens.) /___/___/___/___/___/___/___/___/___/
2. INITIALS / VOORLETTERS /___/___/___/___/___/___/___/___/(NAME / NAAM)
_____________________
3. SURNAME /
VAN
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
4. MEMBERSHIP
NAME ( if not to be registered under surname or an
individual)
LIDMAATSKAP NAAM ( indien
nie geregistreer moet word onder die van of as dit nie ‘n individu is nie)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
ID. NUMBER:
5. ID. NOMMER:
/__/___/___/___/___/___/___/___/___/___/___/___/___/
ADDRESS OF APPLICANT / ADRES VAN AANSOEKER
6. ADDRESS
LINE 1
ADRESLYN 1 /___/_ __/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
7. ADDRESS LINE 2
ADRESLYN 2 /___/_ __/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
8. ADDRESS
LINE 3
ADRESLYN 3 /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
9 . POSTAL CODE TELEPHONE
NUMBER
POSKODE
/___/___/___/___/ TELEFOON
NOMMER ( _________)(________________)
FAX CELL
FAKS:
(_______)(___________________) SEL: ________________________________
10. E-MAIL ADDRESS
E-POS ADRES :
____________________________________________________
11. LANGUAGE IN WHICH CORRESPONDENCE IS REQUIRED:
TAAL WAARIN KORRESPONDENSIE VERLANG WORD: AFRIKAANS /___/ ENGELS /___/
DO HEREBY
APPLY FOR PARTICIPATION / DOEN HIERMEE
AANSOEK
12. PARTICIPATION
REQUIRED AS FROM D D
M M
C C Y
J
DEELNAME
WORD VERLANG VANAF /__/___/ /___/___/
/___/___/___/___/
TYPE OF PARTICIPATION FOR WHICH
APPLICATION IS MADE
TIPE DEELNAME WAARVOOR
AANSOEK GEDOEN WORD
INDIVIDUAL PARTICIPANT / INDIVIDUELE DEELNEMER
/ 1 / COMPANY / MAATSKAPPY /
2 /
PARTNERSHIP / VENNOOTSKAP / 3 / NUMBER OF PARTNERS / AANTAL VENNOTE /__/__/
BODY CORPORATE / REGSPERSOONLIKHEIDSLIGGAAM / 4 /
TRUST /
5 /
13. WERE YOU FORMELY OR ARE YOU AT PRESENT A PARTICIPANT OF ANY BREED
SOCIETY WITH REGARD TO THE SAME OR
ANY OTHER BREED?
IS U HUIDIGLIK
OF WAS U VOORHEEN ‘N DEELNEMER VAN ENIGE TELERSGENOOTSKAP TEN OPSIGTE VAN
DIESELFDE OF ENIGE ANDER RAS? YES/JA /___/ NO/ NEE /___/
IF YES, STATE
HEREUNDER THE BREED SOCIETY AND YOUR PARTICIPANT NUMBER, IF AVAILABLE.
INDIEN JA, MELD
HIERONDER VAN WELKE GENOOTSKAP EN VERSTREK U DEELNEMERNOMMER, INDIEN
BESKIKBAAR:
BREED SOCIETY / NUMBER RASGENOOTSKAP:________________________________
NOMMER :_________________________
HERD PARTICULARS / KUDDEBESONDERHEDE
__________________________________________________________________________________________________
KEEPER / OPSIGTER
(The Keeper is the person where the animals are, if this person is the
same as the participant, skip (items 1,2,3) / Die Opsigter is die die persoon
by wie die diere loop, indien hierdie persoon dieselfde is as by die deelnemer,
los (items 1,2,3 )
__________________________________________________________________________________________________
1. TITLE (indicate PROF., DR., MR., MRS., MISS., etc.)
TITEL (meld PROF., DR., MNR., MEV., MEJ.,
ens.)
/__ _/___/___/___/___/___/___/___/___/
2. INITIALS / VOORLETTERS /__ _/___/___/___/___/___/___/___/
3. SURNAME /
VAN
/__ _/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
4. FARM NAME
PLAAS
NAAM /__TAFELKOP_/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
5. TOWN OR CITY
NEAREST TO YOUR FARM / DORP OF STAD NAASTE AAN U PLAAS
/BLOEMFONTEIN___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
POSTAL ADDRESS WHERE YOUR CORRESPONDENCE MUST BE SENT
TO:
MELD DIE POSADRES WAARHEEN U KORRESPONDENSIE GESTUUR
MOET WORD
6. ADDRESS LINE 1
ADRESLYN 1 /__ _/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
7. ADDRESS
LINE 2
ADRESLYN 2 /___FAUNASIG/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
8. ADDRESS LINE 3
ADRESLYN 3 /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
9. POSTAL CODE TELEPHONE
NUMBER
POSKODE /___/___/___/___/ TELEFOON NOMMER (_______)(______________________)
FAX/FAKS: (_______)(______________________) CELL /SEL______________________________________
10 E-MAIL ADDRESS
E-POS ADRES :
____________________________________________________
11. MY CHOICE FOR HERD DESIGNATION MARKS
ARE: Please supply six [6] combinations
in order of preference
MY KEUSE
VIR KUDDEKENMERK IS: Verstrek asb.
ses [6] kombinasies in orde van voorkeur
A)
/__/___/___/___/ B) /___/___/___/___/ C)
/___/___/___/___/
D)
/___/___/___/___/ E) /___/___/___/___/ F)
/___/___/___/___/
12. MY/OUR
CHOICE FOR A HERD NAME (PREFIX) IS / MY/ONS KEUSE VIR KUDDENAAM (VOORVOEGSEL)
IS:
(Please supply six [6] combinations
in order of preference) / (Verstrek
asb. Ses [6] keuses in orde van voorkeur.) Names of towns and cities are not
allowed. / Name van dorpe en stede word nie toegelaat nie
13. PREFIX /
VOORVOEGSEL
A) /_ __/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
B)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
C) /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
D)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
E)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
F) /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
I AGREE TO OBSERVE AND BE BOUND BY
THE CONSTITUTION AND THE RULES, REGULATIONS AND BYE-LAWS OF SA STUD BOOK AND
THE DORMER SOCIETY / EK ONDERNEEM OM MY
AAN DIE BEPALINGE IN DIE GRONDWET EN DIE REëLS, REGULASIES EN VERORDENINGE VAN
SA STAMBOEK EN DIE DORMER GENOOTSKAP TE ONDERWERP.
ATTACHED FIND A LIST OF ALL STUD
BOOK ANIMALS CURRENTLY IN MY POSSESSION / AANGEHEG VIND U ‘N LYS VAN AL DIE
STAMBOEK DIERE WAT EK TANS IN MY BESIT HET.
A CHEQUE FOR THE AMOUNT OF R__________ IN PAYMENT OF THE FOLLOWING IS
ATTACHED / ‘N TJEK VIR DIE BEDRAG VAN R _________ TER BETALING VAN DIE VOLGENDE
WORD HIERBY INGESLUIT:
Stamboek fooie/Studbook fees (01.07.2006 - 30.06.2007)
ANNUAL SUBSCRIPTION / JAARLIKSE SUBSKRIPSIE - R 150-00
DIRECT DEALING / DIREKTE HANDELING - R 175-00
REGISTRATION OF PREFIX /
VOORVOEGSEL REGISTRASIE - R 95-00
SUB TOTAL / SUB TOTAAL R 390-00
VAT /
TAX 14% R 54-60
TOTAL / TOTAAL R 444-60
STAMBOEK BANKBESONDERHEDE VIR DIREKTE
INBETALING/STUDBOOK BANKING DETAILS FOR DIRECT PAYMENT: Standard Bank 04 119
1358 – Tak Brandwag:05 55 34
(Above
mentioned fees are valid until 30 June 2003 / Bogenoemde gelde is geldig tot en
met 30 Junie 2003)
A CHEQUE FOR THE AMOUNT OF R__________ IN PAYMENT OF THE FOLLOWING IS
ATTACHED / ‘N TJEK VIR DIE BEDRAG VAN R _________ TER BETALING VAN DIE VOLGENDE
WORD HIERBY INGESLUIT:
DORMER GENOOTSKAP FOOIE/DORMER SOCIETY FEES
Intreefooi/Entry
fee R300-00
Ledegeld/Membership R350-00
Birthnotification
Book/Geboortekennisgewingboek R80-00
R730-00
R12-50 HEFFING
PER DIER 12 MAANDE EN OUER SOOS OP 1JULIE EN R5 PER GEBOORTE AANMELDING/
R12-50 LEVY PER ANIMAL 12 MONTHS AND OLDER AS ON 1 JULY
AND R5 FOR EVERY BIRTHNOTIFICATION
DORMER BANKBESONDERHEDE/BANKING DETAILS
Standard Bank –
Rek Nr: 041206363
Brandwag tak:
055534
PAYMENTS MUST BE INCLUDED AND MADE OUT ON SEPARATE
CHEQUE FOR BOTH ORGANISATION AND CHEQUES MUST BE ATTACHED OR WE WILL NOT BE
ABLE TO PROCESS THE APPLICATION
BETALINGS MOET GESKIED MET APARTE TJEKS VIR BOGENOEMDE
INSTANSIES ANDERS SAL DIE AANSOEK
SIGNED AT THIS DAY
ONDERTEKEN TE ____________________ HIERDIE ______ DAG
VAN ____________________ 20_____.
_____________________________
_____________________________
SIGNATURE OF APPLICANT SIGNATURE OF SOCIETY
HANDTEKENING VAN APPLIKANT HANDTEKENING
VAN GENOOTSKAP
LIST OF STUD ANIMALS OF THE BREED OF THE
SOCIETY WHICH YOU ARE JOINING
|
REGISTRATION NUMBER REGISTRASIENOMMER |
IDENTIFICATION IDENTIFIKASIE |
SEX GESLAG |
NAME OF ANIMAL NAAM VAN DIER |
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1.
Which
is your nearest town, Post Office or Railway Station?
Watter is u naaste dorp, Poskantoor of
Spoorwegstasie?
2.
Distance
from town, Post Office or Railway Station?
Afstand van dorp, Poskantoor of
Spoorwegstasie?
__________________________________________________________________________________
3.
On
which main road and in which direction is you farm?
Op watter hoofpad en in watter
rigting lê u plaas?
__________________________________________________________________________________
4.
Kindly
furnish a good sketh indication of the road to your farm with distance in
kilometres
Verstrek asseblief ‘n duidelike skets waarop u
die pad na u plaas aandui met afstande in kilometres
SKETS/SKETCH
In the event of a partnership one of these documents
must be completed for EVERY partner in the partnership and these documents must
accompany the application for membership / In geval van >n vennootskap moet een van hier-die dokumente volledig
voltooi word vir elke vennoot in die vennootskap en moet die dokumente die
aansoek om lid-maatskap vergesel.
I / EK,
1. INITIALS
VOORLETTERS
/___/___/___/___/___/___/
2. NAME AND
SURNAME / NAAM EN VAN
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
3. TITLE (State PROF., DR., MR., MRS., MISS., etc.)
TITEL (Meld PROF., DR., MNR., MEV., MEJ., ens.)/___/___/___/___/___/___/___/___/
4. ADDRESS LINE 1
ADRESLYN
1
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
5. ADDRESS LINE 2
ADRESLYN 2
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
6.
ADDRESS LINE 3
ADRESLYN 3 /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
7. POSTAL CODE
TELEPHONE NUMBER CODE
POSKODE
/___/___/___/___/ TELEFOON NOMMER
_________________KODE_____________
CEL
SEL: _______________________________________________
8. E-MAIL ADDRESS
E-POS ADRES :
____________________________________________________
THAT APPLIED
FOR MEMBERSHIP UNDER THE MEMBERSHIP NAME:
WAT AANSOEK GEDOEN
HET
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
DO HEREBY AGREE AND ARE BOUNDED TO BE HELD JOINTLY AND SEPARATELY
RESPONSIBLE FOR PAYMENT OF ANY MONIES DUE AND PAYABLE TO THIS ASSOCIATION AS
MAY BE PAYABLE FROM TIME TO TIME /
ONDERNEEM EN IS GEBONDE
"Gevolmagtigde verteenwoordiger
van vennootskap soos bepaal op 'n vergadering van die
vennote gehou op ...................200....
Authorised representative
of partnership as determined at
a meeting of partners held on ..........................200....
Naam /
Name:
................................................
Adres / Address: .....................................................................
......................................................................
......................................................................
SIGNED AT
THIS DAY OF
ONDERTEKEN TE ___________________ HIERDIE ______ DAG
VAN __________________ 20_____.
_________________________
SIGNATURE OF
PARTNER
HANDTEKENING
VAN VENNOOT
FOR COMPLETION
BY THE DIRECTORS/MEMBERS OF COMPANIES/CLOSE CORPORATIONS
VIR VOLTOOIING
DEUR DIE DIREKTEURE VAN MAATSKAPPYE/BESLOTE KORPORASIES
I/We (full
names and addresses please)
Ek/Ons (volle
name en adresse asseblief)
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
in my/our
capacity as Director of the Company/individual members of the close corporation,
declare myself/ourselves prepared in our personal capacities to be held
responsible for the payment of the outstanding debts of the Company/Close
Corporation
in my/ons
hoedanigheid as Direkteure van die Maatskappy/individuele lede van die Beslote
Korporasie, verklaar myself/onsself hiermee bereid om in ons persoonlike
hoedanigheid verantwoordelik te wees vir die vereffening van die uitstaande
skulde van die Maaatskappy/beslote Korporasie.
Voltooiing
deur direkteure van Maatskappye/Beslote Korporasies .
" Gevolmagtigde
verteenwoordiger van maatskappy, private maatskappy of
regspersoon soos bepaal op 'n
vergadering van
die direkteure / lede gehou op ...................200....
Authorised
representative of company,
private company or body corporate as determined at a meeting of directors / members
held on ..........................200....
Naam /
Name:
...................................................
Adres /
Address: .....................................................................
......................................................................
......................................................................
.....................................
SIGNATURES/HANTEKENINGE SIGNATURES/HANTEKENINGE
_____________________________ ___________________________
_____________________________
___________________________
_____________________________
___________________________