SOUTH AFRICAN WARMBLOOD
HORSE SOCIETY
PO BOX 32847 KYALAMI 1684 SOUTH AFRICA
Tel: (+27) 11 702 2220 Cell: 083 260 6495 Fax: 086 684 9407
E-MAIL , WEBSITE www.sawarmbloodhorses.com
BREEDER MEMERSHIP FORM
I/WE,
1. TITLE: (indicate PROF., DR., MR., MRS., MISS., etc.) /___/___/___/___/
INITIALS: /___/___/___/_ (NAME)______
SURNAME: /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
4. ID. NUMBER: /___/___/___/___/___/___/___/___/___/___/___/___/___/
5. VAT NO.: _/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
(Please attach a copy of the VAT certificate.)
6. JOB DESCRIPTION
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
ADDRESS OF APPLICANT:
7. /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
8. /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
9. /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
10. POSTAL CODE: /___/___/___/___/ TELEPHONE NUMBER: (______) (______)
FAX: (______)(______) CELL:______
11. E-MAIL ADDRESS: ______@______
12. PARTICIPATION REQUIRED AS FROM D D M M C C Y Y
/___/___/ /___/___/ /___/___/___/___/
13. TYPE OF PARTICIPATION:
/ 1 / INDIVIDUAL PARTICIPANT
/ 2 / PARTNERSHIP:* Number of partners: /__/__/
/ 3 / COMPANY *
Registration no.: /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
/ 4 / BODY CORPORATE *
Registration no.: /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
/ 5 / TRUST *
Registration no.: /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
* Attatch the following:
a) Please attach the extract of the minutes reflecting the decision.
b) Full name and address of the shareholders.
c) Written approval of signatories.
* Authorised person ______
14. Were you formerly or are you currently a member of any Breeder’s Society with regard to the same or any other breed?
YES /___/ NO /___/
If YES, state the name of the Breeders’ Society below as well as your participant number, if available:
BREED SOCIETY: ______
NUMBER: ______
YOUR STUD NAME WITH THEM ______
STUD PARTICULARS
15. FARM/ PROPERTY NAME:
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/__/__/__/__/
16. TOWN OR CITY NEAREST TO YOUR PROPERTY:
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
POSTAL ADDRESS WHERE YOUR CORRESPONDENCE MUST BE SENT TO:
17. ADDRESS LINE 1
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
18. ADDRESS LINE 2
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
19. ADDRESS LINE 3
/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
20. POSTAL CODE: /__/__/__/__/
TELEPHONE NUMBER: (______)(______)
FAX: (______)(______) CELL: ______
21. E-MAIL ADDRESS: ______@______
22.
GPS CO-ORDINATES (if available): ______
MY/OUR CHOICE FOR A STUD NAME (PREFIX) IS:
(Please supply FOUR (2) combinations in order of preference.)
PREFIX
A) /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
B) /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
C) /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
D) /___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/
I AGREE TO OBSERVE AND BE BOUND BY THE CONSTITUTION AND THE RULES, REGULATIONS AND BYE-LAWS OF THE SAWARMBLOOD HORSE SOCIETY
SIGNED AT ______THIS ______DAY OF ______20_____
______
SIGNATURE OF APPLICANT OR AUTHORISED PERSON SIGNATURE OF SOCIETY
LIST OF HORSES ALREADY IN YOUR POSSESION THAT MAKE UP YOUR STUD.
ORIGINALNAME OF ANIMAL / SEX STALLION, FEMALE, GELDING / COLOUR, HEIGHT AND ANY OTHER
IDENTIFICATION / DATE OF BIRTH / OTHER