Golden Bird Patron Application Form

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

Personal Information

Title*

First Name*

Surname*

Company / Trust Name

Identity Number

Date of Birth

Contact Details

Telephone (Work)

Mobile Number*

Email Address*

Address

Physical Address*

Postal Code*

Postal Address (if different from physical)

Postal Code

Patron Category

Please select your preferred giving tier:

Select Category*

Section 18A Tax Certificate Information

Required for your tax-deductible donation certificate. Complete if your details differ from the personal information above.

Full Name of Donor / Company / Trust

Unit Number

Complex / Building Name

Street Number & Name

Suburb

City

Postal Code

Postal Address (if different from physical address)

Postal Code

Identification / Passport / Company Registration Number

Identification Type

Identification Number

Country of Issue

Tax Reference Number

Contact Person

Contact Tel / Cell Number

Contact Email Address

Proof of Payment

Please attach your proof of payment. Remember to reference your payment with your name, surname and GBP.

Upload Proof of Payment*

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

Accepted file types: PDF, JPG, JPEG or PNG. Maximum file size: 10 MB.

Declaration

Declaration*

I confirm that the information provided is accurate and I agree to become a Golden Bird Patron of BirdLife South Africa.

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