TRACE ALERT LOGGED

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Membership Number
Date	19 May 2012
Please process the Trace Alert and inform us immediately you have a response. We understand that the Trace Alert Report Back will cost us R 71-10 Exclusive of VAT.
Enquiry Reason	(Select a reason) Credit Application Credit Limit Management Insurance Application Insurance Claim Employment and/or Educational Check Fraud, Corruption, or Theft Investigation Fraud Detection and Fraud Prevention Continuous service provision limit Unclaimed funds distribution Affordability / Financial means assessment Propensity to Repay Other
Surname	*
First Name or Initials	*
Identity Number	*
Comment/Reason
We accept the disclaimer from Accountability as agreed to on our membership application. Please deduct the once off transaction fee of R27-50 Excl VAT for the Trace Alert Logged from our bank account. We assure you that the above information is true and correct and when clicking on the submit button accept this submission as your approval for Accountability to proceed.