Gift 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"
......................................................................................................................

My cheque (made payable to The Wits Foundation) is enclosed

I have made my gift online at www.fundraising.wits.ac.za

I have completed my details overleaf for a gift via

credit card/direct deposit
Please send me more information about making a bequest to Wits

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

in the amount of: ...................... Once only Every month

Tel. No.: (............) ............................................................................................
Signature: .............................................................. Date: ...............................
I/we acknowledge that the party hereby authorised to effect the drawing(s) against my/our account may not cede or assign
any of its rights to any third party without my/our prior written consent and that I/we may not delegate any of my/our
obligations in terms of this contract/authority to any third party without prior written consent of the authorised party.
Thank you for your co-operation.

Internet Bank Transfer or Direct Deposit

I have deposited my donation into your bank account.
Bank: Standard Bank of South Africa Limited
Account Name: Wits Foundation Number Two Account
Account Number: 00 290 0076
Branch Code: 00 48 05
Swift Code: SB - ZAZ - AJJ - 480502
*Please be sure to include your full name as the reference, so we may thank you for
your gift and send you your official tax receipt

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)

Tel. No. (H): (.......) ..................................... (B): (.......) .....................................

Name : .............................................................................................................
Address: ..........................................................................................................
......................................................................... Postal Code: .........................