Membership

Get your AFIA membership today

Please please fill in the form bellow and submit your membership application for approval.

APPLICATION FOR MEMBERSHIP

 

    1. Name of Official authorised to sign this application on behalf of the FSP

    First Name

    Last Name

    ID Number

    E-mail address

    Cell Number

    Designation

    2. FSP Name

    FSP Number

    Website (if applicable)

    Affiliated FSP numbers (if applicable):

    Company/Close Corporation number (if applicable):.

    VAT number (if applicable)

    Office Physical address:

    Postal address:

    Contact telephone numbers:

    Compliance officer name and contact number:

    Total number of key individuals:

    Total number of representatives:

    Total number of other staff:

    B-BBEE Status:

    3. BUSINESS LINES & TOTAL PREMIUM UNDER MANAGEMENT

    Long Term %:

    Short Term %:

    Financial planning %:

    Healthcare %:.

    Employee Benefits %:

    4. APPLICATION, DECLARATION AND UNDERTAKING

    I, We the undersigned, hereby apply for Membership of African Financial Intermediaries Association (AFIA). I authorize them to make any investigation or enquires with any person or Organisation they may deem necessary to obtain any information they need.
    I accept the Executive Committee shall have the final say in my application and shall not enter into any correspondence regarding its decision. I declare that, to the best of my knowledge and belief, all the aforegoing information id true and correct.
    Your membership will only commence once your application has been approved by the National Office and membership allocate I/We further undertake to advise the Association of any changes in the business or in the information given in this application form, which changes might reasonably be expected to influence the decision of the Association concerning my/our continued membership and to pay promptly all amounts due to the Association.
    In the event of my/our termination of membership, I/we undertake to give the Association one calendar months’ notice, settle any outstanding fees and to remove the Association’s logo from my/our letterheads and stationery and to return the membership certificate to the Association.

    DECLARATION

    Please chose the appropriate response
    (a) Have you held or applied for AFIA Membership in the past? YES / NO
    (b) Has your business or any of its KIs ever been denied membership YES / NO or had their membership terminated by any industry organisation.
    (c) Are you a member of other association YES / NO

    Signature

    By confirming this check box you are submitting a digital signature.
    Please prove you are human by selecting the Heart.

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