INSURANCE INSTITUTE OF KWAZULU-NATAL
MEMBERSHIP APPLICATION 2015
On behalf of ______(Company/Individual),
I hereby apply for the following individuals to be members of the Insurance Institute of KwaZulu-Natal for the period
1 January to 31 December 2015 for ______members @ R75.00 each = R ______
Name / Email / Membership Number**Companies applying for membership for more than 10 persons are asked to attach the list in an Excel spreadsheet**
Approved and accepted by: Office Representative Details:
Signed : ______Name : ______
Name : ______E-mail : ______
Tel No : ______
Email : IIKZN Bank Details
Contact : Sandra Pratt 031 251 5000 Standard Bank ABC
: Vanitha Kalicharan 039695 1093 Account No: 050402102
: Seshin Moodley 031 830 6017 Bank Code: 040126
: Mala Govender 031203 4113 Reference: Mem-[Company/Individual Name]
***PLEASE SEND APPLICATION FORM AND PROOF OF PAYMENT TO SANDRA PRATT VIA EMAIL***
The IIKZN as the service provider agrees and covenants that it shall:
(i) keep and maintain all your personal information in strict confidence, using such degree of care as is appropriate to avoid unauthorized access, use or disclosure;
(ii) use and disclose your personal information solely and exclusively for the purposes for which the personal information, or access to it, is provided pursuant to the terms and conditions of your membership, and not use, sell, rent, transfer, distribute, or otherwise disclose or make available personal information for the IIKZN’s own purposes or for the benefit of anyone other than yourself without your prior written consent; and
(iii) not directly or indirectly, disclose personal information to any person (an Unauthorised Third Party) other than IIKZN Council members, any agents, outsourcers or accountants, without express written consent from you, unless and to the extent required by Government Authorities or as otherwise, to the extent expressly required, by applicable law, in which case, the IIKZN shall:
(i) use best efforts to notify you before such disclosure or as soon thereafter as reasonably possible;
(ii) be responsible for and remain liable to you for the actions and omissions of such Unauthorized Third Party concerning the treatment of such personal information as if they were the IIKZN’s own actions and omissions; and
(iii) require the Unauthorized Third Party that has access to personal information to execute a written agreement agreeing to comply with the terms and conditions of this Agreement, relating to the treatment of personal information.”