Please complete this form if you are a UCT staff member and would like to pay by staff payroll. Name Surname Email Phone number Department at UCT Staff Number UCT Staff number Amount R100 R200 R500 R1000 Other amount R How often - None -Once offMonthly How Many Payments? How Many Payments? Otherx2x3x6x12Open-endedOther… Enter other… If you selected, monthly, please select how many times you would like to donate? Projects 100Up Programme AfriFund Project Alumni in Action Archbishop Desmond Tutu Chair in Urology Baxter Residence Commerce Crisis Fund Covid-19 Relief Fund EBE SOS Fund Excellence in Law Khusela Ikamva Sustainable Campus Project Jagger Library Mayosi Impilo Bursary Fund Rhodes Must Fall Scholarship Science Learning Centre SRC Assistance Fund Student Financial Aid Student Funding – Postgrad Funding Summer School UCT Fire UCT Food Programme Uyinene Scholarship Other Other If Other: Please Specify