NEW ACCOUNT REGISTRATION

First Name:*

Last Name:*

Username/e-Mail Address:*

Contact No:*

Upload Image:

Note: Image size should be less than 2 MB and only .jpg/png extension allowed

Municipality:* --Select Municipality-- Matatiele Municipality Umzimvubu Municipality Ntabankulu Municipality Winnie Madikizela-Mandela Municipality

Village:* --Select Village--

Ward Number:

Ward Councillor:

Physical Address:

Password:*

Confirm Password:*