PRIORITY DEBENTURE
RESERVATION FORM		  
 
Agent Registration Code
Title Mr. Mrs. Miss Dr. Proff. Other
Surname
First Name & Initials
Postal Address
 
 
  Code
  Date of Birth
  I.D. Number
Telephone Work: Home: Cell:
  Email
   
Code Debenture
Type 		Cash
Price 		Tick Where Applicable   Banking Details
Cash Credit Card Cheque Savings   * Only Complete Preferred Method of Payment
SD Single R 8995   Name of Bank
CD Couple R11570   Branch of Bank
FD4 Family of 4
or Less		 R12860   Branch Code
FD6 Family of 6
or Less		 R14150   Cheque Account No.
FD8 Family of 8
or Less		 R15440   Credit Card No.
FD9 Family of 9
or More		 R16730   Savings Account No.
GD Gold R 3000      
First Names of Debenture Users
please indicate Gold preference with (G)		 1 2 3 4 5
6 7 8 9 10

Note:

  • There is no limit to the number of debentures purchased by any one purchaser.
  • Gold debentures at R3000 per card holder secures reservation rights at any time per day.
  • In the event of the spouse not having the same surname as the applicant, documentary proof must be submitted.
  • Documentary proof of parenthood may be required.
  • Debenture membership Agreement & Rules:
    Each debenture holder will be expected to sign a membership agreement.
    Each user will adhere to the rules and regulations to ensure the safeguarding and good order of the centre.



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