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    Bursaries Learner Registration Form v1

    Uploaded by

    nonkululekoh2

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Bursaries Learner Registration Form v1

    Uploaded by

    nonkululekoh2
    4 views3 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4 views3 pages

    Bursaries Learner Registration Form v1

    Uploaded by

    nonkululekoh2

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    BURSARIES LEARNER REGISTRATION FORM

    1. COMPLETE IN BLACK PEN ONLY


    2. ATTACH CERTIFICIED COPY OF ID
    3. CONFIRMATION OF EMPLOYMENT
    4. ATTACH BURSAR'S ADMISSION LETTER FROM UNIVERSITY
    5. PROOF OF INCOME TO ENSURE THAT THE BENEFICIARY INCOME/FAMILY INCOME IS BELOW THE R600 000.00
    p.a. THRESHOLD.

    ARE YOU FUNDED BY NSFAS OR ANY SETA OTHER THAN SERVICE SETA YES NO
    If Yes Please Specify the Name of the Funder:

    SECTION A: PARTICULARS OF THE LEARNER

    Learner Surname Learner First Name


    Learner Middle Name Title (Mr. Mrs. Ms)
    Learner ID Number Date of Birth
    Gender Male Female
    African Coloured Indian
    Equity Code/Race
    Other (Specify)
    RSA Dual (SA Plus Other Other (Specify)
    Nationality Code/Citizen Status

    Employment Status Employed Unemployed

    Home Language

    STATS SA Area
    Learner Home Address Code (search DHET
    SETMIS on google)

    Learner Home Postal Code


    City: Urban
    Municipality
    Rural
    (If Yes Specify)
    Disability Yes No
    Province
    Learner Contact Details Learner Cell Phone Number: Learner Fax Number: Learner Email Address:

    .
    HIGH SCHOOL AND HIGHEST QUALIFICATION COMPLETED
    Last School Name: Last School Year: Last School EMIS No:
    Learner High School Details

    High School Address


    Highest Qualification Completed

    PARTICULARS OF HIGHER EDUCATION INSTITUTION


    Institution
    Registration
    Institution Name Number (CIPC)
    Accreditation Number
    Institution Type Public Private)
    Institution Address

    Postal Code
    Institution Phone Number

    Institution Contact Person Email Address


    Province Institution SDL No

    PARTICULARS OF STUDY
    Qualification Name

    Qualification ID (SAQA ID)

    Registration date

    .
    PARTICULARS OF EMPLOYER (ONLY IF THE BURSAR IS EMPLOYED)
    SETA Registered (If
    Employer Name not SSETA)
    SDL No SIC Code
    Employer Registration Number
    (i.e 2021/1234322/07)
    Employer Postal
    Employer Postal Address Code
    Employer Contact
    Employer Phone Number Email Address
    Employer Contact Person
    Province

    LEARNER DECLARATION
    Please note that the guardian signature is required if the learner is under 18 years
    1. I declare to the best of my knowledge that all information on this form is true and correct, and I understand that if it is
    not, I may be eliminated from consideration in the selection process. If after being granted a bursary, any falsehood or
    omissions are discovered in my application, I understand that my bursary grant may be terminated.

    2. I undertake to avail myself for participation in all structured learning, practical workplace experience and assessment
    activities required by the bursary scheme.

    3. I indemnify the Service SETA and its officials against any claim for illness or accidental injury sustained by me in the
    workplace and during operations in the attainment of the bursary scheme objectives.

    4. I authorise the Service SETA to deal directly with the Institute on my behalf and receive copies of my progress reports
    quarterly and results.
    Name and Surname of the Learner
    Signature of the Learner Date
    ONLY APPLICABLE IF THE LEARNER IS A MINOR
    Name and Surname of the Parent or
    Guardian
    Signature of the Parent or Guardian Date

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