Professional Documents
Culture Documents
PIF Bursary Pledge Form
PIF Bursary Pledge Form
My relationship to Wits:
Alumnus Student Parent Friend of Wits
Name: ..........................................................................................................
Postal address: ...........................................................................................
....................................................................... Postal code: ........................
Country: .......................................................................................................
Contact telephone number: ........................................................................
Fax number: ................................................................................................
E-mail: .........................................................................................................
Cellphone: ...................................................................................................
I enclose my gift to the Chancellor’s Annual Fund
R ............................
Are you interested in supporting a specific project or faculty or may
we allocate the donation for you? Please indicate below:
......................................................................................................................
"Pay it Forward Bursary"
......................................................................................................................
Official website address: www.fundraising.wits.ac.za • Telephone number: (011) 717-9703 • Fax number: (011) 717-9729
Queries: Contact the Development & Fundraising Office • E-mail address: fundraising.development@wits.ac.za
9051
Gift options
Credit Card
Please debit my MasterCard/Visa Card
(Last 3 digits on
Card no.: reverse of card)
Expiry Date: M M Y Y
Debit Order
I wish to sponsor by debit order an amount of .................................. to
The Chancellor’s Annual Fund, University of the Witwatersrand on the
first day of ............................ 2008 and each month thereafter.
Account No.: ...................................................................................................
Type of Account: Current Transmission Savings
Bank/Building Society: ...................................................................................
Branch Name & Address: ...............................................................................
..........................................................................................................................
City/Town: ......................................................... Branch Code: .....................
Signature: ............................................................. Date: ................................
(as for signing cheques)