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BLACK CONVEYANCERS ASSOCIATION
[APPLICATION FOR ACCREDITATION]
{PLEASE COMPLETE IN BLOCK LETTERS}
SURNAME: _____________________________________________________________________
NAME/S: _____________________________________________________________________
ID NR: _____________________________________________________________________
ADDRESS: _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
CODE: _____________________________________________________________________
TEL. NR: _____________________________________________________________________
FAX NR: _____________________________________________________________________
CELL: _____________________________________________________________________
E-MAIL: _____________________________________________________________________
TERTIARY EDUCATION:
ARTICLESHIP:
ADMISSIONS [Year] : ATTORNEY: CONVEYANCER:
LAW SOCIETY WHERE REGISTERED:
EMPLOYMENT HISTORY:
PRACTICE& BEE STATUS:
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OWNERSHIP [Name of Firm]
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ARE YOU A DIRECTOR/ MEMBER / OWNER
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YES
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NO
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BLACK OWNERSHIP
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WHITE OWNERSHIP
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%
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%
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DETAILS OF INVOLVEMENT IN ANY ASSOCIATIONS/JOINT VENTURE:
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[Full details of such Agreement]
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DETAILS OF PROFIT SHARING AGREEMENT:[Where applicable]
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[The Executive Committee reserves the right to request supporting documents in respect of the above]
*** Please attach copy of Identity document
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