Act For Change card application

Organisation details

Registered name of organisation *

Type of organisation *

Short overview of organisation's focus area *

Website

NPO registration number

Non-profit organisation (NPO) certificate

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Proof of NPO address

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Are you a public benefit organisation (PBO) in terms of section 18A of the income tax Act? *

Physical address of organisation

Country *

Street name and number *

Town/Suburb/Township *

Province *

Postal code *

Personal information

Title *

First name *

Last name *

Contact number *

e.g. +27 12 345 6789

Invalid phone number

Date of birth *

Email *

Invalid email address

The emails you entered do not match

Upload representative ID document *

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Position in the organisation *

I hereby confirm that the information provided is true and correct and that I have the authority to do so.

Preferences

Statement receipt preference *

I agree to receive important account information via SMS

Please select a brand *

Are additional cards required? *

I confirm that the details provided are true and correct and that I have the authority to do so. See the Shoprite Group's Data Privacy Statement here. *