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

There was an error uploading the file. Please try uploading file again.

Proof of NPO address

There was an error uploading the file. Please try uploading file again.

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 *

Suburb/Township *

Province *

Postal code *

Personal information

Title *

First name *

Last name *

Contact number *

e.g. +27 12 XXX XXXX

Invalid phone number

Date of birth *

Email *

Invalid email address

The emails you entered do not match

Upload representative ID document *

There was an error uploading the file. Please try uploading file again.

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. *