APPLICATION FOR REGISTRATION AS A CAREGIVER

DEPARTMENT OF SOCIAL DEVELOPMENT OLDER PERSONS ACT, 2006 (ACT NO.13 OF 2006

- Confirm DSD Caregiver Registration*I confirm that I'm hereby registering as DSD Caregiver and NOT SAAHA (Executive) Member
- Details of Applicant
- SECTION A:
- Username*
- Password* Enter a strong password: minimum length of 8 characters, including uppercase as well as lowercase characters, numbers and non-alphabetical characters (@#$%^&*() etc.
- Repeat Password*
- Name*
- Surname*
- Preferred Name*
- ID Number*
- Date of Birth*
- Age (years)
- Nationality*
- Gender*
- Physical Address
- Address 1*
- Address 2
- Suburb
- City / Town*
- Province*
- Postal Code*
- Country*
- Postal Address
- Same as Physical Address
  - Yes
  - No
- Postal Address
- Postal Address Postal Code
- Postal Address Country
- Contact Details
- Mobile Phone Number Required phone number format: (###) ###-####
- Home Phone Number Required phone number format: (###) ###-####
- Work Phone Required phone number format: (###) ###-####
- Fax Number Required phone number format: (###) ###-####
- Email Address*
- EDUCATION (Attach copies of relevant certificates)
- *** Maximum 4 Educations. Use the '+' symbol to add more, the '-' symbol to delete an education
- ×The maximum number of fields has been reached.
  - ×+
  - School / College / University
  - Standard / Qualifications
  - Date
  - ×+
  - School / College / University
  - Standard / Qualifications
  - Date
- OTHER TRAINING (Attach copies of relevant certificates)
- *** Maximum 4 Courses. Use the '+' symbol to add more, the '-' symbol to delete an education
- ×The maximum number of fields has been reached.
  - ×+
  - Course / Qualification
  - Institution
  - Date
  - ×+
  - Course / Qualification
  - Institution
  - Date
- Convicted of a Criminal Offence
- Yes / No
  - Yes
  - No
- Details
- SECTION B:
- Certified Attachments
  Maximum 5 attachments. Combine similar document types in zip files if you need to submit more than 5 attachments. Click on the '+' symbol to add another attachment, the '-' symbol to delete an attachment.
- Certified Copy of ID*
- Certified Certificate(s)
  *** Combine in a zip file if more than one.
- Other Certified Documents
  *** Combine in a zip file if more than one.
- More Detail about Other documents, if attached
- Declarations and Signature Attachment
  I declare that the above information is true and correct. I understand that any misinterpretation or omission of pertinent information may be considered as sufficient grounds for withdrawal of registration.
- Yes*
  - Yes
- Place*
- Date*
- Your Full Name*
- Signature Instructions
  Please fill in the fields above. Then print this page (using the Print button at the bottom of this page). Sign it in the Signature field, scan the signed page into your computer and attach it to this registration using the Signed Caregiver Registration button below, before clicking the blue REGISTER button.
- Signature Signature
- Signed Caregiver Registration

Welcome to SAAHA – Championing the cause of the elderly and those who care for them since 1990

SAAHA Membership

APPLICATION FOR REGISTRATION AS A CAREGIVER

DEPARTMENT OF SOCIAL DEVELOPMENT OLDER PERSONS ACT, 2006 (ACT NO.13 OF 2006

Details of Applicant

SECTION A:

Physical Address

Postal Address

Contact Details

EDUCATION (Attach copies of relevant certificates)

*** Maximum 4 Educations. Use the '+' symbol to add more, the '-' symbol to delete an education

OTHER TRAINING (Attach copies of relevant certificates)

*** Maximum 4 Courses. Use the '+' symbol to add more, the '-' symbol to delete an education

Convicted of a Criminal Offence

SECTION B:

Certified Attachments

Declarations and Signature Attachment

Signature Instructions