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Membership Application for HE and associated institutions

Submitted by admin on Tue, 01/03/2022 - 16:28

Membership Application for HE and associated institutions

This application form is for universities, TVET and CET Colleges, and associated standards and research institutions

By applying for Membership of the Consortium:

You agree to be subscribed to our email lists.
You will receive information from PURCO SA about contracts and tenders, as well as news and event invitations.
Please follow PURCO SA's social media accounts.
You may request to have your data removed or unsubscribe from emails at any time.

Your details (Required)

Start here to check if your details are already listed *

The dropdown shows the first 25 matches. Type more letters of the name to see more results

Prefix *

First Name *

Last Name *

Job Title *

Existing contact data on the database is not shown to protect your information. Please re-enter below to proceed.

Phone Number

Country code

Phone number

Cellphone

Country code

Cellphone number

Your work email *

Start typing to check if your institution is already listed *

The dropdown shows the first 25 matches. Type more letters of the name to see more results

Institution Name *

Your institution details

Website

Co. Registration no

SARS Tax reference number

Brief description of institution

Where do you have campuses *

Eastern Cape

Free State

Gauteng

KwaZulu-Natal

Limpopo

Mpumalanga

Northern Cape

North West

Western Cape

Namibia

No of campuses or offices (including head office/main campus)

You may provide contact details for up to 9 campuses

Main address (Required)

Postal Address *

Postal Address 2

Postal Address Line 3

City *

Postal Code

Country *

Province *

Main campus/office Phone *

Country code

Phone number

Main campus/office Email *

Campus/Office 2

Address Name

Phone Number

Email (branch office 2)

Street Address

Street Address Line 2

Street Address Line 3

City

Postal Code

Province

Country

Campus/Office 3

Address Name

Phone Number

Email (branch office 3)

Street Address

Street Address Line 2

Street Address Line 3

City

Postal Code

Province

Country

Campus/Office 4

Address Name

Phone Number

Email (branch office 4)

Street Address

Street Address Line 2

Street Address Line 3

City

Postal Code

Province

Country

Campus/Office 5

Address Name

Phone Number

Email (branch office 5)

Street Address

Street Address Line 2

Street Address Line 3

City

Postal Code

Province

Country

Campus/Office 6

Address Name

Phone Number

Email (branch office 6)

Street Address

Street Address Line 2

Street Address Line 3

City

Postal Code

Province

Country

Campus/Office 7

Address Name

Phone Number

Email (branch office 7)

Street Address

Street Address Line 2

Street Address Line 3

City

Postal Code

Province

Country

Campus/Office 8

Address Name

Phone Number

Email (branch office 8)

Street Address

Street Address Line 2

Street Address Line 3

City

Postal Code

Province

Country

Campus/Office 9

Address Name 9

Phone Number

Email (branch office 9)

Street Address

Street Address Line 2

Street Address Line 3

City

Postal Code

Province

Country

B-BBEE and tax details (Required)

VAT number

B-BBEE level *

B-BBEE recognition % *

B-BBEE and tax clearance certificates (optional)

B-BBEE Certificate

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf.

B-BBEE certificate expiry date

Day

Month

Year

Tax Clearance Certificate / Pin

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf.

Tax clearance expiry date

Day

Month

Year

Institution logo and images (recommended)

Images:
You are encouraged to upload your company logo and up to four images that reflect your institution. They will be displayed on your Member Profile page. The logo and images should be 330 pixels wide x 260 pixels tall. If the files you upload are a different size they will be automatically resized and cropped to fit.

Logo

Files must be less than 1 MB.
Allowed file types: gif jpg jpeg png.

Profile image 1

Files must be less than 300 KB.
Allowed file types: gif jpg jpeg png.

Profile image 2

Files must be less than 300 KB.
Allowed file types: gif jpg jpeg png.

Profile image 3

Files must be less than 300 KB.
Allowed file types: gif jpg jpeg png.

Profile image 4

Files must be less than 300 KB.
Allowed file types: gif jpg jpeg png.

Institution type

Type of institutionIndicate the type of institution.

Data privacy

Data privacy *

I confirm that I have read and agree with the PURCO SA Data Privacy Policy

Your data will be stored on this website and its backups. We will never sell your details to any other company. Our privacy policy can be read here. You may change or delete your information at any time.

Type of Organization

Leave this field blank

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