WINELANDS – Membership Application 2026 Step 1 of 4 25% CompanyThis field is for validation purposes and should be left unchanged.SECTION A / AFDELING AName of Landowner / Naam van grondeienaar(Required)Name of Lessee (if applicable) / Naam van Huurder (indien van toepassing)Name of Property / Naam van Eiendom(Required)Trading name / HandelsnaamLocal Municipality / Plaaslike Munisipaliteit(Required)Contact Details / Kontak besonderhedeOwner Cell Phone No. / Eienaar Selfoon No.(Required)Manager Personal Name / Bestuurder Persoonlike NaamOwner Email Address / Eienaar Epos Adres(Required) Manager Cell Phone No. / Bestuurder Tel No.Manager Email / Bestuurder Epos AdresAccount Contact Details / Rekeninge Kontak besonderhedeAccount Contact Name / NaamAccount Contact Cell / SelAccount Contact Email / EposVAT No. / BTW No.Postal Address / Pos Adres(Required) SECTION B - INSURANCE / AFDELING B - VERSEKERINGInsurance Company (not broker) / Versekeringsmaatskappy (nie makelaar)Do you have Fire Suppression cover (non-structural)? / Het u brandbestrydingsdekking (nie vir geboue)?(Required) Yes / Ja No / Nee Do you have Aerial Resource (e.g. Helicopter) Cover? / Het u dekking vir lug (bv.. Helikopter) ondersteuning?(Required) Yes / Ja No / Nee SECTION C (All farm portions MUST be adjoining) / AFDELING C (Alle plaas porsies MOET langs mekaar wees)Latitude / BreedegraadLongitude / LengtegraadMap of Farm Attached / Kaart van plaas aangeheg? Yes / Ja No / Nee Upload Farm Map (PDF/JPG) / Laai kaart opAccepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 40 MB. Closest Main Road / Naaste HoofpadFARM PORTIONS / PLAAS PORSIESPortion No 1Title Deed Number (No 1)Farm Name (No 1)Portion/Erf Number (No 1)Area Size (No 1)Portion No 2Title Deed Number (No 2)Farm Name (No 2)Portion/Erf Number (No 2)Area Size (No 2)Portion No 3Title Deed Number (No 3)Farm Name (No 3)Portion/Erf Number (No 3)Area Size (No 3)Portion No 4Title Deed Number (No 4)Farm Name (No 4)Portion/Erf Number (No 4)Area Size (No 4)Orchards, Vineyards / Boorde, Wingerde (ha)Field Crops, Cultivated fields / Droëlanderye, landerye (ha)Natural Veld / Natuurlike Veld (ha)Other / Ander (specify / spesifiseer) (ha) + Other description / Ander beskrywingSECTION D - ADJACENT NEIGHBOURS / AFDELING D - AANGRENSENDE BUREAdjacent Neighbours / Aangrensende BureFarm Name / Plaas NaamNeighbour Name / Bure NaamNeighbour Cell No / Bure Sel No Add RemoveSECTION E / AFDELING E — Comms + personnel + equipment + declarationRadio Frequency / FrekwensieEmergency Channel Frequency / NoodkanaalfrekwensieWhat communication platform is used / Watter kommunikasieplatform word gebruik?Are you on the WFPA WhatsApp group for your area (ward) / Is u op die WFPA WhatsApp groep vir u area (wyk)? Yes / Ja No / Nee No group in area / Geen groep in area Personnel / PersoneelBasic Firefighting for Veld & Forest Fires / Basiese Brandbestryding vir Veld- & BosbrandeAmount / GetalControlled Burning / Beheerde BrandeAmount / GetalFire Boss or IC Type 5Amount / GetalTrained personnel - First Aid / Opgeleide personeel - NoodhulpFirst Aid Level 1 / Noodhulp Vlak 1Amount / GetalFirst Aid Level 1 / Noodhulp Vlak 3Amount / GetalBAA or higher / BAA of hoërAmount / GetalBasic Firefighting for Veld & Forest Fires / Basiese Brandbestryding vir Veld- & Bosbrande (Amount / Getal)Amount / GetalTraining Requirements / Opleidings BehoeftesTotal Staff Contingent / Totaal werks personeel(Amount / Getal)Equipment / Toerusting:Tanker with capacity >1000l / Tenker met kapasiteit >1000lQuantity / HoeveelheidTanker with capacity <1000L / Tenker met kapasiteit <1000LQuantity / HoeveelheidSkid unit (300-700l) / Bakkie sakkie (300-700l)Quantity / HoeveelheidWater trailer (incl capacity) / Spuitkar (ingesl kapasiteit)Quantity / HoeveelheidWajax can, Knapsack sprayer / Wajax kan, RugsakpompQuantity / HoeveelheidAvailable dams / Beskikbare dammeQuantity / HoeveelheidAvailable dams / Beskikbare dammeQuantity / HoeveelheidFilling point normal / Volmaakpunt normaalQuantity / HoeveelheidFilling point overhead / Volmaakpunt oorhoofsQuantity / HoeveelheidFire Beater / VuurplakkeQuantity / HoeveelheidRake hoe / VuurharkeQuantity / Hoeveelheid2 Way Radio / 2 Rigting RadioQuantity / HoeveelheidLanding Strip / LandingstrookQuantity / HoeveelheidOther / AnderSECTION F / AFDELING FAny firebreaks on your property? Yes / Ja No / Nee Any firebreak agreements done with neighbours? Yes / Ja No / Nee (if yes, please send a copy to WLFPA)Sent a map of the firebreak to WLFPA? Yes / Ja No / Nee DECLARATION / VERKLARINGI accept the rules and regulations of this FPA / Ek aanvaar die reëls en regulasies van hierdie BBV Yes, I accept and agree. / Ja, ek aanvaar.Signature / Handtekening(Required)NB!! The information declared by acknowledging the information will be relevant in terms of compliance to the rules and regulations of the WFPA in terms of the Act and pertinent to consequence of a fire incident on the property. ADDENDUM A: FIRE PREPAREDNESS & FPA COMPLIANCE CHECKLIST BYLAE A: BRANDGEREEDHEID & BBV NAKOMINGS KONTROLELYSGENERAL / ALGEMEENAre you aware of the landowner’s responsibilities under the National Veld and Forest Act? / Is u bewus van die verantwoordelikhede as n grondeienaar ingevolge die Nasionale Wetop Veld en Bos? Yes / Ja No / Nee In your absence do you have a responsible person on or near the property who will take steps to extinguish the fire, has gate keys/ codes and emergency contact numbers? / In u afwesigheid het u 'n verantwoordelike persoon op of naby die eiendom wat stappe sal neem om die brand te blus, hek se sleutels / kodes en noodnommers het? Yes / Ja No / Nee Are the emergency numbers visible for all? / Is die noodnommers sigbaar vir almal? Yes / Ja No / Nee Have you discussed possible evacuation plans with all residents and made provision for any animals? / Het u moontlike ontruimingsplanne met die inwoners bespreek, en voorsorg getref vir enige diere? Yes / Ja No / Nee Have you discussed fire risk & fire spread insurance with your broker? / Het u brandrisiko- & brandverspreidingsversekering met u makelaar bespreek? Yes / Ja No / Nee FIRE RISK / BRAND RISIKODo you know the past frequency of veldfires in your area? / Is u bewus van die veldbrand geskiedenis in die area en hoe gereeld veldbrande voorkom? Yes / Ja No / Nee Have you identified the possible causes or direction of approach of a veldfire? / Het u die moontlike oorsake of beste benadering in terme van voorkoming van 'n veldbrand geïdentifiseer? Yes / Ja No / Nee Have you identified possible social/economic impacts of a veldfire? / Het u die moontlike sosiale/ekonomiese gevolge van 'n veldbrand geïdentifiseer? Yes / Ja No / Nee Have you identified possible environmental impact of a veldfire? / Het u die moontlike omgewingsimpak van 'n veldbrand geïdentifiseer? Yes / Ja No / Nee PROPERTY / EIENDOMHave you isolated any hazard area that is present or likely to develop? / Het u enige gevaar gebied geïsoleer of moontlik sal kan ontwikkel verwyder? Yes / Ja No / Nee Is there easy access for firefighters to property and high risk areas? Roads, signage, gate codes,disabling of electric fences and gates, turning circles for trucks? / Is daar maklike toegang vir die brandweer tot eiendomme en hoë risiko gebiede? Paaie,naamborde, hekkodes, afskakel van elektriese heinings & hekke, draai sirkels vir vragmotors? Yes / Ja No / Nee Are you undertaking efforts to clear the invasive alien plants on your property? / Word pogings aangewend om die indringerplante op u eiendom skoon te verwyder? Yes / Ja No / Nee Do you have stacks of dry logs, branches and leaves on your property? / Het u stapels droë stompe, takke en blare op die eiendom? Yes / Ja No / Nee Do you have designated areas and policies about smoking on your property? Are all residents, employees, contractors and visitors made aware of them? / Het u spesifieke gebiede en beleid rakende rook op u eiendom? Word alle inwoners, werknemers, kontrakteurs en besoekers daarvan bewus gemaak? Yes / Ja No / Nee Do you have rules for any possible fire causing work (e.g.. Power tools) with steps to preventrunaway veldfires? Are all relevant employees & contractors made aware of these? / Het u reëls vir enige moontlike brand veroorsakende werk (bv.. Elektriese gereedskap) met stappeom wegholveldbrande te voorkom? Word alle relevante werknemers & kontrakteurs hiervan bewusgemaak? Yes / Ja No / Nee BUILDINGS / GEBOUEInstalled thatch roof sprayers? Are they in good working order? / Installeer grasdakspuite? Is hulle in goeie werkende toestand? Yes / Ja No / Nee Cleared a defendable space of 30m around buildings? Cut grass, isolated pruned shrubs and trees, fire proof plants? / Het u 'n verdedigbare ruimte van 30 m rondom die gebou skoongemaak? Gesny gras, geïsoleerde gesnoeide struike en bome, vuurvaste plante? Yes / Ja No / Nee Cleared all fire hazards 10m around buildings? Including cleaned gutters, under wooden deck, against walls, overhanging branches? / Het u die brandgevare van 10 meter rondom geboue uit die weg geruim? Sluit geute ingesluit, onder die houtdek, teen mure, oorhangende takke? Yes / Ja No / Nee I, as landowner completed Addendum A truthfully and to the best of my ability. I acknowledge and give permission that a check may be performed to ensure that the information on Addendum A is correct, and the landowner is compliant to the best of his/her ability. Ek, as grondeienaar Addendum A eerlik en na die beste van my vermoë voltooi het. Ek erken gee toestemming dat 'n inspeksie gedoen mag word om te bepaal of die grondeienaar voldoen aan die vereistes, en ook die nodige stappe neem om te voldoen om veldbrande te voorkom op sy eiendom.
