Donation Application Form - Capitec Foundation Trust Page 6
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6Undertaking
I hereby certify the correctness of figures/data/information/documents furnished herewith. I also undertake to provide further particulars
as required by Capitec Foundation and to abide by the rules, regulations and instructions issued by the Foundation from time to time.
Signature
Print initials and surname
Designation
Date
Postal address: Corporate Social Investment Department, PO Box 12451, Die Boord, Stellenbosch, 7613
email:
Board of Trustees: C Fischer (Chairman), LJ Rose, L Moodley
Page 6 of 6
Registration Number: IT2097/2014
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