Update personal Details form

Update of Contact Details Form

SA Nursing Council Reference Number

Title

Dr. Mr. Ms. Prof.

Name

Surname

Maiden Name (if applicable)

South African Identity Number

Passport Number (if applicable)

Province

City/Town

Suburb/Village

Street Name (if village capture your nearest point of presence e.g School , Clinic , Community Creche, Shop etc.)

Postal Code

Email Address

Cell Phone Number

Other Telephone Number

Employers Name

Practise Number for Private Practitioners

Declaration

I HEREBY CERTIFY that the information provided in this form is complete, true and correct to the best of my knowledge. FURTHER, I HEREBY ACKNOWLEDGE that I have read and understood the POPI Act, 2013 and agree thereto as well. I give my consent to the SANC to collect, use and process my personal information. I understand that my consent does not preclude the existence of other criteria for lawful processing of personal data, and does not waive any of my rights under the POPI Act , 2013 and other applicable laws.