Application For Membership: Please Note That Details Marked With An Asterisk Are Mandatory For All Members

1. The document is an application for membership to the Actuarial Society of South Africa. It requests personal details, contact information, employment history, qualifications, and recommendations from two referees. 2. Applicants must agree to be bound by the Society's disciplinary procedures and privacy policy. Referees must confirm the applicant is a fit and proper person for membership. 3. Supporting documents like identity documents and academic records must be attached.

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Application For Membership: Please Note That Details Marked With An Asterisk Are Mandatory For All Members

Uploaded by

Albert Ingwani

Available Formats

Download as PDF, TXT or read online on Scribd

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Submit completed forms to: PO Box 4464 Cape Town, 8000, RSA Tel.

+27 (0)21 509 5242 Fax. +27 (0)21 509 0160 www.actuarialsociety.org.za Actuarial Society of South Africa c/o Old Mutual Office 2 2nd Floor West End Mall Jan Smuts Drive, Pinelands 7405

Application For Membership

*Please note that details marked with an asterisk are mandatory for all members.

Personal Details Applicant (Please PRINT in BLOCK CAPITALS using black ink) *Title (Circle) *First Names (in full) "Applicant" *Surname *ID Number For Non-SA applicants Passport Number *Date of Birth Gender Nationality Male / Female Race Black / Coloured / Oriental / White / Indian Mr / Miss / Ms / Mrs / Dr Other (Please Specify)

Contact Details *Postal Address: Tel. Mobile Tel. Work Tel. Home Fax. Work *Postal Code Fax. Home *Email Residential Address: Business Address:

*Postal Code

Membership details Applying for Membership as: Affiliate Library Fellow Associate Student Yes Staff No

Are you currently a member of the Actuarial Society of South Africa? If so, please provide your Member Number: Are you currently a member of another Actuarial Society / Faculty / Institute? If so, please specify which and provide your Actuarial Reference Number: Have you ever been refused membership of this or any other Professional Body? If so, please provide particulars on a separate page.

Yes

Employment Details Employment Sector: Other (Please Specify) Life / Pensions / Investments / Short-Term Ins / Health / Banking / Currently Unemployed Employer

Qualifications / Degrees obtained Qualification Qualification Institution Institution Year Year

Actuarial Society of South Africa Role(s) Current participation in any of the structures or activities of the Actuarial Society of South Africa: Body Body Role Role

Declaration by Applicant: By signing this declaration, I confirm and agree that, to the extent allowed by law: I am familiar with the constitution, bye-laws, guidance on professional conduct and the privacy policy issued by the Actuarial Society (all these documents can be obtained from the Actuarial Society), and understand that I am obliged to remain familiar with these documents;

by submitting this application, I am bound by the disciplinary procedure and guidance on professional conduct issued by the Actuarial Society from time to time;
I hereby authorize the Actuarial Society to obtain information on my disciplinary record from the organisation referred to above.

no disciplinary investigations are pending against me and if there are, I have provided sufficient details thereof in a document attached to this application; I expressly accept the privacy provisions included in the privacy policy of the Actuarial Society and the terms of the privacy policy are expressly incorporated herein by reference; and I expressly consent to allow the Actuarial Society to collect, receive, record, organize, collate, store, update, modify, retrieve, alter, consult, sue, disseminate, disclose and process personal information as provided for in the privacy policy.

This declaration constitutes acknowledgments of fact by the Applicant. The Application must read the declaration carefully and ensure that each statement is true and correct as this will limit the rights of the Applicant to claim that these statements are not true and correct. The Actuarial Society may also have claims and other rights against the Applicant if any statement is not true and correct. I have read and accept the privacy policy of the Actuarial Society. (please tick box) Applicants Signature: Date:

Recommendation and declaration by two Referees: (N.B. For applications for Student Membership one of the referees should be the approved actuarial academic from the applicants university where such a person exists.) (to be completed by a Fellow member of the Actuarial Society) Name (please PRINT) Professional Body (or Academic Post) Relationship to Applicant Address (to be completed by a Fellow / other professional / university academic)

Declaration: By signing this declaration, I confirm and agree that, to the extent allowed by law, I have known the applicant for at least one year and, to the best of my knowledge and belief, consider him/her to be a fit and proper person to be a member of the Actuarial Society of South Africa. This declaration constitutes acknowledgments of fact by the Referee. The Referee must read the declaration carefully and ensure that each statement is true and correct as this will limit the rights of the Referee to claim that these statements are not true and correct. The Actuarial Society may also have claims and other rights against the Referee if any statement is not true and correct. Date Signature of Referee

Approved by Council

Date

Documents to be attached: Certified Copy of South African Identity document For foreign students, certified copy of passport If you are concurrently applying for membership of another Actuarial body, or if you have already been accepted or refused membership of another Actuarial body, full details must be attached to this Application Form. If you have previously been a member of the Actuarial Society of South Africa and wish to reactivate your membership, you must provide proof of your full academic record. If you are applying for Fellow/Associate membership on the basis of Mutual Recognition of a qualification obtained through another actuarial body please contact the Administrative Office of the Actuarial Society for further information.

Additional Information To Be Completed For Student Membership The Admissions Committee, on behalf of Council, will at its discretion normally admit as a student member an applicant who has achieved the academic requirements as set out on the Societys website subject to satisfactory conduct.

Please PRINT all details clearly (or CIRCLE the correct option where applicable) in BLACK ink.

Do you comply with the Student Admission Requirements as set out on the Societys website?

Yes

Academic Information

High School Information Last High School attended Examining Body Year Completed Country

University Information University 1 University 2 University 3 Qualifications Obtained List the various Actuarial Science / Mathematical Subjects completed at university (together with marks obtained): Mathematics Mathematical Statistics Actuarial Science Years Attended Years Attended Years Attended

What is the highest university qualification you have obtained? What is the highest university actuarial science qualification you have obtained?

None / Bachelors / Honours / Masters / Ph.D. None / Bachelors / Hons / Higher

List the examinations of the Actuarial Society from which you have been recommended for exemption:

Documents to be attached: Original Official University Academic Record(s) (i.e. not simply a printout from a website) Certified copy of school-leaving certificate