APPLICATION FORM

FOR ADMISSION TO

THE INSTITUTE OF RISK MANAGEMENT
SOUTH AFRICA

As an

Individual Member

NOTE: COPYRIGHT OF THIS MATERIAL EXISTS WITH THE INSTITUTE OF RISK MANAGEMENT SOUTH AFRICA

THE INSTITUTE OF RISK MANAGEMENT SOUTH AFRICA

APPLICATION FOR CONSIDERATION AS AN INDIVIDUAL MEMBER OF THE INSTITUTE

1. Your Details:
Title
Surname
First Name/S
Initials
Date Of Birth
Sa Id Number
Non Sa Passport Number
Demographics (please circle)
(Please note this is for SAQA record purposes on the National Learners’ Records Database) / BA (Black: African)
BC (Black: Coloured)
BI (Black: Indian/Asian)
Wh(White)

ATTACH: Certified Copy of ID (SA Residents) or Passport (Non SA Residents)

2. Employer Details:
Current Employer
Your Position
Work Tel
Work Fax
Work Email
Postal Address
Postal Code
Physical Address
VAT Number

ATTACH: Proof of Employment

Y / N

3. Is your Organization an IRMSA Corporate Member?

4. Home Contact Details
Postal Address
Box Number
Postal Code
Area/Province/State/Country
Physical Address
Building Number and Name
Street Number
Street Name
Suburb/City
Province/State/Country
Contact Details
Tel Number
Cell Number
Other Contact number
Personal Email

Page 1 of 5Application Form – Institute of Risk Management South Africa Version April 2014

1. Educational and Professional Experience

1.1Education History

  • Completed Studies (Qualification, Subjects, Name of Institution and Year Awarded)
  • Current Studies (Qualification, Subjects and Name of Institution)
  • Short Courses (Qualification, Subjects and Name of Institution)

1.2Professional or Academic Qualifications

  • Professional Qualifications e.g. CA (SA), CIA etc. (Institution, Date Awarded)
  • Membership of Professional Associations: (Name of Association, Member Details)

Page 1 of 5Application Form – Institute of Risk Management South Africa Version April 2014

2. Experience

2.1Risk Management Related Experience

Number of Years of Risk Management Experience:

2.2Other experience

Number of Years of Other Experience:

2.3Specify field of expertise

Banking & Financial Services / Mining Oil & Gas
Education / Shipping & Logistics
Electronics, Telecoms and Communications / Tourism & Hospitality
Insurance / Re-Insurance / Trading & Distribution
Industrial Machinery / Engineering: consultancy and construction
Medical & Pharmaceutical / Petrochemicals & Chemicals.
Professional Services / Other (Please Specify)
Technology

2.4What is your focus?

Operational Risk
Strategic Risk
Both

3.Contributions to Risk Management

If the following information is not detailed in your CV, please provide us with:

Full details of articles published (Title and Printing Medium)

Lecturing, Teaching and Training (Name of Lecture / Course Material and Where Provided)

4.What is your primary reason for joining IRMSA?

Networking
Professional Development and Education
Tools and Resources
Marketing

5. How did you find out about IRMSA?

Internet/Website
Publication – please specify :
Email
Colleagues
Other – please specify:______

6.Provide a Brief Motivation / Reasons Why You Wish To Belong to the Institute:

Checklist – please ensure you have attached the following with your completed signed application form and agreed to the Terms and Conditions:

  • Certified Copy of ID (SA Residents) or Passport (Non SA Residents)
  • Proof of Employment (Non SA Residents) – a letter from employer stating position, date of commencement of employment, current dated, signed.

For further information contact Zandie Nyembe at IRMSA (011) 555 1800 or

Page 1 of 5Application Form – Institute of Risk Management South Africa Version April 2014