APPLICATION FOR NAME TO BE INSCRIBED ON WALL

Gunners' Association - Wynter Prevost Memorial Wall

Please provide the following information in as much detail as possible to: Gunner W. Wassermeier – Deputy National President on e-mail:
wallofremembrance@gunners.org.za

DETAILS OF THE DECEASED/BESONDERHEDE VAN DIE OORLEDENE

Rank of the deceased Gunner. Oorlede Kannonier se Rang.
Initials of the deceased Gunner. Oorlede Kannonier se Voorletters.
Surname of the deceased Gunner. Oorlede Kannonier se Van.
Formasie/Regiment/Eenheid/Hoofkwatier waar oorlede Kannonier gedien het.
Date of birth of the deceased Gunner. Oorlede Kannonier se gebortedatum.
Date of death of the deceased Gunner. Oorlede Kannonier se sterftedatum.
Service number of the deceased Gunner. Oorlede Kannonier se Magsnommer/Identiteitsnommer.

APPLICANTS CONTACT DETAILS/AANSOEKER INFORMASIE

Name and Surname of the Applicant. Aansoeker se Naam en Van.
Applicants E-Mail Adress. Aansoeker se e-Posadres.
Applicants Contact Telephone No. Aansoeker se telefoon kontaknommer.
I confirm that I have obtained the permission of the family to place their ancestor on the Wall of Remembrance and/or I have tried my best to locate them without success and I take full responsibility in the event of any comeback.

COSTS/KOSTES

The plaque costs R 800.00 per plaque.

Please enter any amount which you would like to donate. Voltooi die bedrag van jou donasie.
Enter the sum of the costs and your donation amount. Voltooi die som van die kostes en jou donasie.

First National Bank

Gunners’ Association

Account number: 50400012329

Branch Code: 252242

Please use the reference: “WOR and name on Row 3 above”
Gebruik as verwysing die volgende: “WOR en die name in Ry 3 bo”

A final proof will be submitted for your approval prior to manufacture and after payment is received.
Your support of the Gunners’ Memorial is greatly appreciated. U ondersteuning van die Kannoniersherdenking word opreg waardeer.
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