MEMBERSHIP
Membership Number: {Enter SAMPRA Membership Number:1024}
GENERAL INFORMATION
Individual or Band: {Are you applying as an individual or as part of a band:3}

BAND INFORMATION

Band Name: {Band Name:1005}
Number of Band Members: {Number of Band Members:1006}
Details of Band Members: {Band Members:899}

PERSONAL INFORMATION OF APPLICANT

Title: {Title:52}
Surname: {Surname:53}
Name: {Name:1018}
Date of Birth: {Date of Birth:1022}
Nationality: {Nationality:57}
SA ID Number / Passport Number: {SA ID Number / Passport Number:58}
Home Language: {Home Language:59}
Postal Address: {Postal Address (Street Address):60.1}, {Postal Address (Address Line 2):60.2}, {Postal Address (City):60.3}, {Postal Address (State / Province):60.4}, {Postal Address (Country):60.6}
Postal Code: {Postal Address (ZIP / Postal Code):60.5}
Residential Address:{Residential Address (Street Address):61.1}, {Residential Address (Address Line 2):61.2}, {Residential Address (City):61.3}, {Residential Address (State / Province):61.4}, {Residential Address (Country):61.6} Residential Code: {Residential Address (ZIP / Postal Code):61.5}
Cellphone Number/s: {Cellphone Number(s):62}
Alternative Contact Number: {Alternative Contact Number:63}
Email Address: {Email Address:64}
Annual Income: {Annual Income:1020}

MUSIC PRODUCTION INFORMATION

Expense Category: {Expense Category:1016}
Amount applied for: {Amount applied for:1019}
Documents
{Documents:35} DECLARATION:
Signature of Applicant
Date: {Signature Date:48}