Applications

APPLICATION FOR REGISTRATION AS AN ETHNO HEALTH PRODUCTS MANUFACTURER,
ETHNOPHARM, AFRICAN TRADITIONAL HEALTH SHOP IN TERMS OF EPASA REGULATIONS

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Name and Surname:

I.D. No:

Network / Company Registration No:

EP/ TRAD HS/ PHC/ MCO Company No:

Date:

Postal Address:

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Residential Address:

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Telephone:

Fax:

Cell:

Website:

Professional Affiliation:

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Type of Business:

Membership of any other Associations:

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REGISTRATION FEES:

ETHNOMEDICINE MANUFACTURER: - R1500.00 & ANNUAL FEE
ETHNOPHARM - R2000.00 & ANNUAL FEE
AFRICAN TRADITIONAL HEALTH SHOP - R1500.00 & ANNUAL FEE

BANK DETAILS

Standard Bank: Greenstone Edenvale:

Account Name: EPPASA:

Account No: 011 054 832

Branch Code: 016-342

By submitting this Application Form, you agree to the terms and conditions outlined on this website. Your submission serves as a digital signature, indicating your acceptance of these terms.

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APPLICATION FOR REGISTRATION AS A PRACTITIONER IN TERMS OF THE SOUTH AFRICAN ETHNOMEDICINE PROFESSIONS BOARD (SAEPB)

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PROFESSION APPLIED FOR

Applications for registration for more than one profession must be submitted on separate application forms.

Mark the required profession below.

TRADITIONAL HEALTH PRACTITIONER:Diagnostic

Ethnomedicine Practitioner - D.EmedEthnopsychology Practitioner – D.EPP

TRADITIONAL HEALTH PRACTITIONER:Non Diagnostic

Ethnomedicine Health Advisor - EHAEthnopsychology Health Advisor - EPATraditional Health Practitioner – THP (to upgrade to Ethno Health Advisor)Ethno Massage Therapist - EMTStudent - STUEthnomedicine Manufacturer / Health Shop

PERSONAL DETAILS REQUIRED

Title:E.g Mr/Mrs/Miss/Ms/ Dr/Prof/T/Dr./Other:

Surname as per your identity document:

Surname under which you wish to be registered:If different from surname on identity Document, attach proof of such as a certified copy of a marriage certificate if these surnames differ.

Full first names:Attach a certified copy of an identity document issuedby the Department of Home Affairs

Nationality:

Identity number:

Date of Birth:

Postal Address:

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Residential Address:

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Telephone:

Fax:

Cell:

Website:

Which South African language(s) can you speak?

Place of Practice: Address

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PROFESSIONAL EDUCATION

What qualifications are you submitting in support of your application (certified copies required) and what are the names and contact details for each educational institution(s).

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PLEASE NOTE THAT THE BOARD RESERVES THE RIGHT TO INSPECT ORIGINAL DOCUMENTS

Please attach a certified copy of your academic record in respect of each course referred to above, stating all subjects and marks obtained.

State the actual duration of each course mentioned above and whether it was a full-time Class attendance, part-time class attendance, distance or correspondence course:

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Are the educational institutions in respect of foreign qualifications (i.e. Qualifications obtained outside South Africa) officially accredited by the education authorities of the country in which they are situated?

Please attach a certified copy as proof of above.

PLEASE NOTE THAT THE BOARD RESERVES THE RIGHT TO REJECT ANY FOREIGN QUALIFICATION OR ANY SOUTH AFRICAN QUALIFICATION NOT ISSUED BY AN EDUCATIONAL INSTITUTION.

All foreign qualifications must be submitted to the South African Qualifications Authority (SAQA) (Tel: (012) 482 0800) for authentication and evaluation in terms of the required South African qualification prior to submission to the Board. SAQA’s evaluation certificate must be submitted together with the application form.

Does the foreign qualification obtained from the above-mentioned educational institution grant the holder thereof the legal right to practise the relevant profession in the country where the educational institution is situated?

Please attach proof of above.

If you hold a foreign qualification and previously practised outside South Africa, you are required to submit proof of being in good standing with the registering authority of each country in which you previously practised.

Were you registered or did you apply for registration previously? If yes where and when?

Attach copies of possible relevant correspondence.

You are most welcome to also attach any further documentation or submit information which in your opinion is relevant and could be of benefit for the correct evaluation of your application.

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REGISTRATION FEES:

You are required to submit the prescribed non-refundable application and Accreditation Panel Interview fee of R600.00, plus pro-rata membership fee for the year. Annual membership fee: R550 (January – December- pro-rata)

You are further required to submit proof of good character (two testimonials).

R250 - Administration/Application Fee (non-refundable): Payable at time of application

R350 - Accreditation Panel Interview Fee (non-refundable): Payable at time of application

R550 - Membership Fee: per annum (January – December) Pro-Rata

R550 - 2nd Modality: Nil per annum as from 1st January 2023 per annum

R1500 - Manufacturing or Health Shop: per annum

Webpage/profile on www.epasa.co.za optional at R250 per annum (including set-up fee) Contact detail will be included in listing only if written permission is received from member.

BANK DETAILS:

Standard Bank: Greenstone Edenvale:

Account Name: EPPASA:

Account No: 011 054 832

Branch Code: 016-342

Your application will NOT be processed without all the following documentation:

Certified copy of ID Document
Certified copies of Qualifications
4 x Colour Passport Photos 2 x Signed Character
References (testimonials)
Copy of Bank Deposit Slip

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Agreement

I hereby certify that all the information provided and documentation submitted is true and correct.I agree that I am liable for annual membership fees unless/until resignation submitted in writing.

By submitting this Application Form, you agree to the terms and conditions outlined on this website. Your submission serves as a digital signature, indicating your acceptance of these terms.

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SCOPE OF PRACTICE ALL CATEGORIES

EPASA CODE OF ETHICS CODE OF CONDUCT