Forms

Ek neem kennis dat Graan SA van agente gebruik maak om die heffings, soos deur Graan SA kongres goedgekeur word, in te vorder. / I take note that Grain SA use agents to collect the levies approved by the Grain SA congress.

*Naam/Name :

*Van/Surname :

*Sel/Cell :

*E-pos adres/E-mail Address :

Posadres/Postal Address :

Tak/Branch (boerevereniging / farmers association) :

*Entiteit waarop graan gelewer word/Entity which grain is delivered under :

*Landboubesigheid/Agent/ Agribusiness :

*Lewerings nommer/Delivery Number :

Landboubesigheid/Agent/Agribusiness :

Lewerings Nommer/Delivery Number :

Landboubesigheid/Agent /Agribusiness :

Lewerings Nommer/Delivery Number :

Landboubesigheid/Agent/Agribusiness :

Lewerings Nommer/Delivery Number :

Agente nie bo gelys nie / Agents not listed above :

Notas / Notes :

*Ek gee hiermee toestermming dat Graan SA die inligting aan die gekose landboubesighede mag stuur vir verhaling van heffings: :

*Ek bevestig dat Graan SA my skriftelik sal inlig indien die heffingsbedrag per ton sou wysig :

I hereby agree that Grain SA may send the information to the selected agribusinesses for collection of levies :

I confirm that Grain SA will notify me in writing should the levy amount per ton change. :

2022 Grain SA Member Levies / 2022 Graan SA Lede Heffings