St Cyprian's School201111912143

							                                                                        St Cyprian’s School
                                                                        CREATING FUTURE LEADERS


Pledge Form

Personal details
Name: _______________________________________________ Date of Birth: (d) _______ / (m) _______ / (y) _____ (___

Postal Address: ________________________________________________________________________________________

_____________________________________________________________________________ Code: _________________

Telephone (h): _______________________ (w): ________________________ (cell): ________________________________

Email address/es: ______________________________________________________________________________________

I am a        Parent         Past Parent         Grandparent          Past Pupil         Staff member     Friend    Supplier

If you are a Past Pupil, please complete the following: Maiden Name: _______________________ Year of leaving school: __________

If you are a relative of a Past Pupil, please provide her/their name(s): ______________________________________________________


    I am comfortable with my pledge being acknowledged publicly and appropriately
    I wish for my pledge to be confidential


My Commitment
I/We wish to invest in the present and future of St Cyprian’s School by contributing:

   A monthly pledge of R________________________ for __________ months (please specify duration of pledge)
   An annual pledge of R________________________ for __________ years (due on or before 31st December each year)
   A once-off pledge of R________________________ _____________ (due on or before 31st December 2008)



My Pledge
Please allocate my pledge towards: (please select the appropriate box)

Creating Future Leaders Project
   The Knowledge/IT Hub
   St Cyprian’s Union Bursary Fund (for a daughter of an old girl to attend the school)
__________________________________________________________________________________
   “…girl-child in Afrika” Bursary ________________________
____________________________________________________________________________________________________
(Should you wish to choose more than one, please indicate percentage to be allocated to each)


Bequest
   I have already made provision for a bequest to St Cyprian’s School in my Will
   I have already made provision for a bequest to St Cyprian’s School by ceding a life insurance policy
   I am considering a bequest to St Cyprian’s School and would like more information



                                                                                  Signature:    __________________________________________
                                                                  St Cyprian’s School
                                                                  CREATING FUTURE LEADERS



My Payment Options
Please select which payment option would suit you.


   Cheque payable to: St Cyprian’s School Foundation (For credit “Creating Future Leaders”)
I enclose a cheque for R………………………….. together with this completed form.


   Debit Order (to be deducted from my bank account, details below)
Account Name: _____________________________________________________________________________________
Bank: __________________________________________ Account: ___________________________________________
Branch name: ____________________________________ Branch code: ________________________________________
Type of Account:        Current        Transmission        Savings


Signed at _________________________________ this ______________ day of ___________________________ 200____


Signature: __________________________________________
I / we acknowledge that the party authorized to effect the drawing(s) against my/our account may not cede or assign any of its rights to any party
without my / our prior consent and that I / we may not delegate any of our obligations in terms of this contract / authority to any party without
prior consent of the authorized party.



   Direct Deposit or EFT
St Cyprian’s School Foundation banking details are as follows:

Account name:       St Cyprian’s School Foundation (Creating Future Leaders)
Bank:               Standard Bank
Branch:             Cape Town
Account number:     070 382 794
Branch code:        020009
Swift number:       SBZAZAJJ
Reference:          Donor: Your surname

                                        All donations will receive a Section 18 (A) tax receipt
                                  qualifying you, the donor, for current tax benefits in South Africa

Thank You
“We sincerely appreciate your contribution to this campaign. Thank you for helping us to achieve the dream
by investing in the future of our girls. You have helped to provide them with the most important gift any child
can receive … Education.”

                                If you would like further information please contact Anton Musgrave
                                         Mobile: 082 445 0788 ● email: anton@futureworld.org

                                    St Cyprian´s School, Gorge Road, Oranjezicht, 8001, South Africa
                                           Tel: +27 (0) 21 461 1090 ● Fax: +27 (0) 21 461 8473
                                   Email: foundation@stcyprians.co.za ● Website: www.stcyprians.co.za