Ultimate Network - Application Form

	ULTIMATE NETWORK
	Membership Application Form Page

	To be part of ULTIMATE NETWORK - you have a few options to fill out the form and return it to us.
	First do the following steps - 1. Fill out the form, 2. Print the form, 3. Sign the form.
	Then do one of the following - A) Post it to : P.O.Box 3202, Witbeeck 1729
	B) Fax it to : (011) 953-5135
	C) If you have the facility to scan the membership form after you signed it then you may E-mail it to : ultimatenetwork@absamail.co.za
	ULTIMATE NETWORK application form

Fill out the form, print it, sign it and Post, Fax, or E-mail it to :

Ultimate Network

P.O.Box 3202, Witbeeck 1729

Fax - (011) 953-5135

E-mail - ultimatenetwork@absamail.co.za

Sponsor's Details

The sponsor is the person in whose network you will be. If you don't know who that person will be, please tick here -

(If you know who your sponsor is, please fill in his/her name and membership nr.) (This is the person in whose team/network you will be)

Sponsor's Name

Membership nr.

(If you know who assisted you, please fill in his/her name and membership nr.) (This is the person who spent time with you and signed you up)

Assisted By

Membership nr.

New Member Details

Title

Full Names

Surname


I.D. Number		Date of Birth


Residential Address :	Postal Address :


Street		Box
Town		Town
City		City
Code		Code


Phone (home)			Phone (business)
Fax			Cell


E-mail

Website

Bank Details

Bank
Branch
Account Type	(e.g. - cheque, savings)
Account Number
Branch Number

I understand that the withdrawals of hereby authorized, will be processed by computer through a system known as the ACB Magnetic Tape Service and I also understand that details of each withdrawal will be printed on my bank statement or an accompanying voucher.

Registration fee: R150-00 ( Includes 1st month membership fee of R75-00 )

Registration fees must be deposited directly into Rock Solid Network (RSN) bank account. The member's name and membership nr. must be entered on the deposit slip in the appropriate reference position. After deposit was made, the deposit slip should be attached to your application form and send to ULTIMATE NETWORK at any of the above-mentioned addresses to ensure that the payment is allocated to the correct member. (You may transfer the fee via the internet)

  RSN - Bank details:
  Bank - ABSA
  Branch - Brixton
  Branch code- 632005
  Account Number - 9064099131

Amount paid: (In words)

If you have paid the money directly to your sponsor, add his/her name and phone nr. here.

Paid To Phone Nr.

Declaration:

All above mentioned information is correct and I understand the marketing plan.

Signed at __________________________ Date __________________

Signature _________________________________________

Please read the conditions on this page, sign at the bottom of the page and send it with your application form .

Conditions

1.0	Only a natural person over the age of 18 years will be allowed to participate in the ULTIMATE NETWORK (UNW ) programme. Companies, closed corporations and trusts can not participate in the ( UNW) programme.

2.0	Each INDEPENDENT SPONSOR ( I S ) is an independent contractor and therefore shall not be considered an employee, representative or agent of UNW. The IS shall also under no circumstances give financial or life assurance advice in terms of his/her appointment.

3.0	The IS undertakes:
3.1	to market the products as an independent contractor, conducting all business from his/her own premises at his/her own costs and expenses; and will have no authority to make any warranty on behalf of UNW.
3.2	to only use marketing material authorised and/or supplied by UNW.
3.3	to indemnify and hold UNW harmless against all claims, demands, penalties, judgements, damages or other liabilities caused either negligently or otherwise, by non-compliance or non-observance by the IS of his/her duties and obligations in terms of this appointment.
3.4	not to hold UNW responsible for the termination of this appointment for any reason whatsoever out of UNW control.

4.0	THE IS has:
4.1	no legal power or authority to bind UNW to any appointment or contract or to incur any debt or other liability or to obtain any credit facilities in the name of, or on behalf of UNW at all.
4.2	no authority whatsoever to make, accept, alter or waive any liability of UNW in terms of any document at all.

5.0	UNW may at its own discretion make alterations:

5.1	to the commission structure from time to time on a fourteen day notice to the IS.
5.2	altering, add or withdraw one or more of its products on a fourteen day notice to the IS.
6.0	UNW shall be entitled to terminate this appointment forthwith, by written notice, if
6.1	the IS commits any act or omission which in the sole discretion of UNW adversely affect, or is reasonably likely to affect, the goodwill or reputation of UNW, its personnel or co- independent sponsors.
6.2	the IS, in any way acts contrary to any stipulation contained in this appointment.

7.0	UNW does not warrant that the service provided shall be error free or will be uninterrupted, and will also under no circumstances be responsible for problems arising from loss of connection, or loss of access by IS 's, or loss of data.

8.0	The IS may sell his membership which can also be inherited or bequeathed.
9.0	This document of appointment, read with the Rules contains the entire agreement between the parties and neither party shall be bound by any other document not reduced to writing and signed by UNW.
10.0	As an independent contractor the IS will be responsible for its own P.A.Y.E. and VAT.

Signed at: __________________________________ Date: __________________

__________________________ ___________________________
Witness Independent Sponsor (member)

Please remember, you first have to SIGN the form before you send it to us.

Are you also excited about this new NETWORK?

Yes

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