Language: Taal:

Membership Application / Renewal Lidmaatskap Aansoek / Hernuwing

Registration No: 3148/01

Section 1: Member Afdeling 1: Lid

Owner Eienaar
Responsible Person Verantwoordelike Persoon
Fire Insurance Brandversekering

Section 2: Farm Detail Afdeling 2: Plaasbesonderhede

Farm Plaas
# Title Deed No (If available) Titelakte Nr (Indien beskikbaar) Farm nr Plaas no Farm Address Plaas Adres Ha
1
2
3
4
5
Total HaTotale Ha
Land Use Plaas Gebruik
Type / Land Tipe / Land Ha
GrazingWeivelde
Cultivated landsLanderye
Significant BushBosbou
Significant TreeBome
ResidentialResidensieel
TotalTotaal

Section 3: Neighbours Afdeling 3: Bure

Farm 1 Plaas 1
Direction Rigting Neighbours Name Bure Naam Contact Number Kontaknommer
North Noord
East Oos
South Suid
West Wes
Farm 2 Plaas 2
Direction Rigting Neighbours Name Bure Naam Contact Number Kontaknommer
North Noord
East Oos
South Suid
West Wes
Farm 3 Plaas 3
Direction Rigting Neighbours Name Bure Naam Contact Number Kontaknommer
North Noord
East Oos
South Suid
West Wes
Farm 4 Plaas 4
Direction Rigting Neighbours Name Bure Naam Contact Number Kontaknommer
North Noord
East Oos
South Suid
West Wes
Farm 5 Plaas 5
Direction Rigting Neighbours Name Bure Naam Contact Number Kontaknommer
North Noord
East Oos
South Suid
West Wes

Section 4: Communication Afdeling 4: Kommunikasie

WhatsApp

Please note that these groups are also used for farm safety issues, please be selective if added to the groups.

Let asseblief daarop dat hierdie groepe ook vir plaasveiligheidskwessies gebruik word, wees asseblief selektief wie by die groepe gevoeg word.

Name Naam Relationship Verhouding WhatsApp Info WhatsApp SOS Cell Number Selnommer

Section 5: Fire Equipment and Resources Afdeling 5: Brandbestrydingstoerusting en Hulpbronne

Please note that this information may be shared with government for statistical purposes.

Let asseblief daarop dat hierdie inligting vir statistiese doeleindes met die regering gedeel kan word.

Personnel Personeel
Type Tipe Qty Antal
Trained Fire FightersOpgeleide brandbestryders
Basic First Aid
Mop-up Crew (semi-skilled) Semi-geskoolde brandbestryders
Equipment Toerusting
Type Tipe Qty Antal
BeatersVuurslaners
Skid unit / Bakkie (300–700L) Bakkie (300–700L)
Water Tankers (700–2500L) Spuitkarre (700–2500L)
Bulk Tankers (2500–4000L)
Water Sources Waterbronne
Type Tipe Quantity / Amount Hoeveelheid
No. of water sources available Aantal waterpunte beskikbaar
Total water available Totale water beskikbaar

Section 6: Annual Fee & Declaration Afdeling 6: Jaarlikse Fooi & Verklaring

Annual Membership Fee Jaarlikse Lid Fooie
Ha Range Ha Omvang Annual Fee Jaarlikse Fooi
0 – 50 haR215.00
51 – 200 haR270.00
201 – 500 haR380.00
501 – 1000 haR490.00
1001 – 5000 haR595.00
5001+ haR705.00
Based on your total Ha, your annual fee is: R— Gebaseer op u totale Ha, is u jaarlikse fooi: R—
Banking Details Bankbesonderhede
Name of BusinessNaam van Besigheid: Absa
Type of AccountTipe Rekening: Cheque AccountTjekrekening
Account NumberRekeningnommer: 9288 264 075
Branch CodeTakkode: 632005
ReferenceVerwysing: Use your membership number or member’s name Gebruik u lidmaatskapnommer of lede naam

Keep your proof of payment for your own record. Hou u bewys van betaling vir u eie rekords.

Declaration Verklaring
I, [full names], as land owner or duly authorized representative, acknowledge that I have read and understood the National Veld and Forest Fire Act, 1998 rules and requirements and that I will be an active member of this FPA as far as my resources allow. Ek, [volle name], as grondeienaar of verantwoordelike persoon, erken dat ek die Nasionale Wet op Veld en Bosbrand Wet van 1998 gelees en verstaan het en ek 'n aktiewe lid van die FPA sal wees.

Please sign in the box below: * Teken asseblief in die blokkie hieronder: *