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MEMBERSHIP APPLICATION  

CREDIT PROVIDERS ASSOCIATION
APPLICATION FOR MEMBERSHIP
   
Name of company or organisation
A company name is required.
Trading name
A trading name is required.
Postal address
A postal addressis required is requiredis required.
Physical address
A physical address is required.
Telephone number
A contact number is required is required. is required.
Fax number
A fax number is required.
Company registration number (optional)
VAT registration number
A vat number is required.

NCR registration number
(For Credit providers only)
(Copy of registration certificate required upon approval)

 (optional)
Category of members applied for
1. Full members must have the ability to provide monthly payment profile information in the name of their entity.
2. Refer to Constitution for criteria pertaining to Full, Associate and Affiliate Membership.




Names of divisions / business units which will be submitting payment profile information
(if any)

Industry category












THIS SECTION APPLIES ONLY TO APPLICANTS FOR FULL MEMBERSHIP
YOU WILL BE REQUIRED TO PROVIDE MONTHLY PAYMENT PROFILE DATA TO ALL ASSOCIATE
MEMBER CREDIT BUREAUX IN TERMS OF THE CREDIT PROVIDERS ASSOCIATION CONSTITUTION
(EXPERIAN, COMPUSCAN, TRANSUNION AND XDS)
   

Which is you primary service provider?





Number of current consumer debtor accounts?
(This figure is to be verified by their appointed auditors on an anual basis)

 (optional)
Are you responsible for the collection of monthly instalments/premiums on their book?



Is this function outsourced to a third party?



Do you have consent to share information with CPA members?



Annual sales
(This figure is to be verified by their appointed auditor on an annual basis)

 R
Annual sales is required.Invalid format.



TO THE MANAGEMENT COMMITTEE OF THE CREDIT PROVIDERS ASSOCIATION
Having acquainted ourselves with the Constitution of the Credit Providers Association, it's aims and the Association’s Code of Conduct for members, we hereby apply for membership of the Association in the membership category as indicated.

Our business details are provided on the understanding that any of these shall remain confidential to the Executive Director of the Association, if we so request.
Signed for and on behalf of the Applicant  
Name of signatory:
A name is required.
Title of signatory: 
A title is required.
Our appointed representative is  
  Name:
A name is required.
Title:
A title is required.

 

 Tel No:
A contact number is required.

 

 Fax No:
A fax number is required.

 

 Cell No:
A cell number is required.

 

 E-mail Address:
An email address is required.
An email address is required.
   
Our alternative representative is  

  

Name:          (optional)

 

 Title: (optional)

 

 Tel No: (optional)

 

 Fax No: (optional)

 

 Cell No: (optional)

 

 E-mail Address: (optional)
   

Please submit a short description / profile of the business which includes an overview of the ownership structure, core business focus, and reason for requesting access to CPA payment profile data.

A short description is required.