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Membership
Step
1
of
2
50%
IMATU MEMBERSHIP APPLICATION
First Name
*
Last Name
*
MR/MRS/MS/DR
Initials
Identity Number
Pay Number
Employment
Permanent
Contract
Gender
Male
Female
Date of Birth
Day
Month
Year
Language
Post
Physical Work Address
Postal Address
Tel No. (W)
Cell No.
Email
Are you currently a member of any other Trade Union
Yes
No
If YES, which Trade Union
EX GRATIA BENEFICIARY NOMINATION
ID No. of Beneficiary
Name of Beneficiary
Contact Number
Relationship to Member
RECRUITED BY (If applicable)
Full Name of Recruiter
Contact Number
Bank Account No.
Bank Code
