AFRIKAANSE BEURSINSTITUUT STUDIELENING AANSOEKVORM 2014

(Aansoeke vir studielenings open op 1 Mei 2013 en sluit stiptelik op

30 September 2013)

HOOFLID (slegs aansoeke met ‘n geldige lidmaatskapnommer sal aanvaar word) MAIN MEMBER (only applications with a valid membership number will be accepted)

Indien u onseker is oor u lidmaatskapnommer / if you are uncertain about your membership number

Skakel: 0861 25 24 23 / Call: 0861 25 24 23

Is u tans ‘n lid of ondersteuner van die Solidariteit Beweging? Are you currently a member or supporter of the Solidarity Movement? Ja/Yes: Nee/No:

Indien wel, waar? If in the affirmative, where? Solidariteit Lidnommer: Solidarity Membership number: Datum aangesluit: Date joined: Dra die hooflid tans by tot Solidariteit Helpende Hand of Afriforum d.m.v ‘n maandelikse debietorder? Does the main member currently contribute to Solidarity Helping Hand or Afriforum by means of a monthly debit order? Indien ja, hoeveel? If in the affirmative, how much? Is u ‘n voltydse werknemer van die Solidariteit Beweging? Are you a permanent employee of the Solidarity Movement?

STUDENT SE BESONDERHEDE

STUDENT’S DETAILS

Studentenommer: Mej/Mev/Mnr: Voorletters: Ouderdom: Student nr: Miss/Mrs/Mr: Initials: Age:

Noemnaam: Van: Name: Surname:

Is u gestremd? Are you disabled?

Studierigting: Study field: Instansie / Universiteit: Institution / University:

Wat doen jy tans? 1ste jr 2de jr 3de jr 4de jr Nagraads Gr 12 What are you currently doing? 1st yr 2nd yr 3rd yr 4th yr Post graduate

Het jy ʼn psigometriese toets gedoen? Did you undergo psychometric testing? In watter jaar sal / het jy met jou studies begin? In which year will / did your studies commence(d)? In watter jaar sal jy jou studies voltooi? In which year will you complete your studies? Gaan jy voltyds / deeltyds studeer? Are you going to study full time / part time?

Taalvoorkeur: Huwelikstatus: Afhanklikes: Language: Marital status: Dependants:

E-pos adres: Faksnommer: E-mail address: Fax number:

Identiteitsnommer: Identity number:

Is u tans ’n leninghouer by Helpende Hand? Did you previously receive a study loan through Helping Hand? Indien ja, by welke beursfonds? If in the affirmative, state the name of the Bursary fund you were helped with? (e.g. Steve Booysen / Arend J de Kock)

Posadres: Poskode: Postal Address: Postal code:

Selfoonnr: Huis: Cell: Home:

Woonadres: Poskode: Residential Postal code: Address:

Vul jou akademiese prestasie van jou top 6 vakke in met betrekking tot jou laaste studies Complete your top 6 subjects as per your latest results 1. % 3. % 5. % 2. % 4. % 6. %

STUDENT SE GADE (indien van toepassing)

STUDENT’S SPOUSE (if applicable)

Noemnaam: Van: Name: Surname:

Identiteitsnommer: Identity number:

Is u ’n lid of ondersteuner van die Solidariteit Beweging? Indien wel, verskaf lidmaatskapnommer: Are you a member / supporter of the Solidarity Movement? If in the affirmative, kindly provide your membership number:

Posadres: Poskode: Postal Address: Postal code:

Werkgewer: Employer:

Werk telefoonnommer & kode: Work telephone number:

Selfoonnommer: Cell:

VADER VAN STUDENT STUDENT’S FATHER

Van: Voorl: Naam: Surname: Initials: Name:

Identiteitsnommer: Identity number:

Is u ’n lid of ondersteuner van die Solidariteit Beweging? Indien wel, verskaf lidmaatskapnommer: Are you a member / supporter of the Solidarity Movement? If in the affirmative, kindly provide your membership number:

Posadres: Poskode: Postal Address: Postal code:

Werkgewer: Employer:

Werk telefoonnommer & kode: Work telephone number:

Selfoonnommer: Cell:

Getroud: Ongetroud: Ongetroud maar woon saam met lewensmaat: Married: Not married: Not married but is living with life partner: Getroud maar woon apart (heg beëdigde verklaring aan): Married but are living apart (attach affidavit): Weduwee / wewenaar (heg sterftesertifikaat aan): Widower / Widow (attach death certificate): Geskei (heg egskeidingsbevel en bewys van onderhoud aan): Divorced (attach decree of divorce & settlement agreement)

MOEDER VAN STUDENT

STUDENT’S MOTHER

Van: Voorl: Naam: Surname: Initials: Name:

Identiteitsnommer: Identity number:

Is u ’n lid of ondersteuner van die Solidariteit Beweging? Indien wel, verskaf lidmaatskapnommer: Are you a member / supporter of the Solidarity Movement? If in the affirmative, kindly provide your membership number:

Posadres: Poskode: Postal Address: Postal code:

Werkgewer: Employer:

Werk telefoonnommer & kode: Work telephone number:

Selfoonnommer: Cell:

Getroud: Ongetroud: Ongetroud maar woon saam met lewensmaat: Married: Not married: Not married but is living with life partner: Getroud maar woon apart (heg beëdigde verklaring aan): Married but are living apart (attach affidavit): Weduwee / wewenaar (heg sterftesertifikaat aan): Widower / Widow (attach death certificate): Geskei (heg egskeidingsbevel en bewys van onderhoud aan): Divorced (attach decree of divorce & settlement agreement) Indien die ouer(s) geskei is en weer getroud is, meld slegs die stiefpa of stiefma se besonderhede indien hulle in die behoeftes van die student voorsien. If the parents are divorced and have been remarried, kindly only supply the details of the stepfather or stepmother if they are providing for the child. Indien die ouer(s) geskei is en geen onderhoud ontvang word nie, hoef die besonderhede van die ouer nie gemeld te word nie. If the parents are divorced and no maintenance is being received, only the details of the caring parent should be provided.

Voorsien ons van kontakbesonderhede van ʼn verwante persoon wat nie by u woonagtig is nie: Kindly furnish us with contact details of a relative that does not reside with you:

Van: Voorl: Naam: Surname: Initials: Name:

Telefoonnommer / Cell: E-pos / e-mail adres

FAMILIE INKOMSTE

FAMILY INCOME

ENIGE EN ALLE INKOMSTE MOET VERKLAAR WORD DEUR DIE VOLGENDE BEWYSE AAN TE

HEG: ALL AND ANY INCOME MUST BE DECLARED BY ATTACHING THE FOLLOWING DOCUMENTS:

1. Die mees onlangse salarisstrokie van beide ouers; 2. In die geval van boere en besighede, bv ‘n eenmansaak, maatskappy of BK, moet die

jongste belastingaanslag van die boer, eienaar of direkteur EN ‘n geouditeerde balansstaat aangeheg word;

3. Inkomste verkry as toelae, pensioen, rente salaris en/of wins uit die koop en verkoop van goedere, kindertoelae ens moet ook verklaar word deur middel van bankstate;

4. In die geval van werkloosheid moet ‘n verklaring deur die werklose persoon afgelê word wat dit bevestig.

5. ‘n Student wat selfversorgend is moet ook ’n salarisstrokie of 3 maande se bankstate aanheg.

AANSOEKE SONDER DIE NODIGE BEWYSE VAN INKOMSTE SAL AS ONVOLLEDIG BESKOU

WORD EN DAAROM NIE VERWERK WORD NIE

1. The most recent payslips of both parents;

2. In the case of farmers and businesses, e.g. a Close Corporation, company or one-man business, the latest tax assessment of the farmer, director or owner AND an audited balance sheet must be attached;

3. Declare and attach proof of any and all income received as allowance, interest, pension, salary and/or profit from buying and selling of goods and child support AND attach the previous 3 months’ bank statements;

4. If unemployed, an affidavit must be attached in which the unemployed person affirm same.

5. A student who is financially independent must attach his/her most recent payslip or 3 months’ bank statements.

APPLICATIONS WITHOUT THE REQUIRED PROOF OF INCOME WILL BE DEEMED INCOMPLETE

AND THEREFORE NOT BE TAKEN INTO CONSIDERATION

Persoon Person

Beroep Occupation

Werkgewer Employer

Jaarlikse bruto inkomste Annual bruto income

Student (indien van toepassing) Student (if applicable

Student se gade (indien van toepassing) Student’s spouse (if applicable)

Moeder van student Student’s mother

Vader van student Student’s father

Voog 1 Guardian 1

Voog 2 Guardian 2

Indien die ouer(s)/voog werkloos is, wie voorsien in die huishouding se basiese finansiële behoeftes? If the parents / guardians are unemployed, who meet the household’s needs?

GESINSBESONDERHEDE

FAMILY DETAILS

Lys alle permanente inwonende gesins- en familielede in jou huis wat afhanklik is van jou ouer(s)/voog se inkomste List all permanent residents that are dependant on the parents / guardians

Heg ‘n afskrif aan van elkeen op die lys se ID of geboortesertifikaat Attach a copy of each person’s ID or birth certificate

Studente: Indien nog gesinslede studente aan tersiêre instansies is, moet bewys van registrasie aangeheg word Students: If any other member of the family is also a student, proof of registration at the University / institution must be attached

Voorletter: Initials:

Van: Surname:

Verwantskap: Relationship:

Ouderdom: Age:

In watter kategorie val hy/sy? In which category does he/she fall?

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ALGEMENE RIGLYNE

LET WEL: U aandag word daarop gevestig dat onvolledige of verkeerde inligting die verwerking van u aansoek kan vertraag of kanselleer. Elke afdeling van die aansoekvorm moet volledig ingevul word. GEEN LAAT AANSOEKE SAL AANVAAR WORD NIE. 1. VOOR-VEREISTES: Om te kan aansoek doen vir ʼn studielening moet u:

Bewys lewer van psigometriese toetsing;

ʼn Lid of ondersteuner van die Solidariteit Beweging wees. Word vandag nog ʼn ondersteuner van Helpende Hand deur ʼn vrywillige bydrae van R50 per

maand te maak. Sien aangehegde debietordervorm.

2. BELANGRIKE DATUMS:

Aansoekvorms kan vanaf 2 Mei 2013 tot 30 September 2013 aangevra word by Melani Gerber

by melani@helpendehand.co.za of telefonies by 012 644 4428, of kan van ons webwerf afgetrek

word by www.helpendehand.co.za. Geen verouderde aansoekvorms mag by Solidariteit

Dienskantore aangevra en ingevul word nie, nuwe aansoekvorms word slegs deur die

Afrikaanse Beursinstituut vanaf Hoofkantoor voorsien.

E-pos of faks asb die volledige voltooide aansoekvorm na Melani Gerber by

melani@helpendehand.co.za of 086 218 3185.

Dit bly die aansoeker se verantwoordelikheid om te verseker dat ons die aansoekvorm ontvang

het. Geen laat aansoeke sal aanvaar word nie.

Die student moet elke jaar her-aansoek doen tussen 1 Mei en 30 September vir hulp vir

die daaropvolgende jaar, dit geld ook vir huidige Helpende Hand studente.

3. DOKUMENTE WAT HIERBY AANGEHEG MOET WORD:

1. Bewys van psigometriese toets afgelê. U is welkom om van Helpende Hand se psigometris gebruik te maak of u eie psigometris te gebruik. Inligting van Helpende Hand se psigometriese toetsing word hierby aangeheg.

2. Gesertifiseerde afskrifte van student en albei ouers se ID dokumente; 3. 1 Maand se salarisstrokie van albei ouers (of student indien hy/sy selfonderhoudend

is). In die geval waar daar geen salarisstrokie beskikbaar is nie, moet 3 maande se bankstate aangeheg word ter bewys van inkomste;

4. Hoogste kwalifikasie bewys, hetsy Matriek sertifikaat / NQF sertifikaat of enige ander

sertifikaat;

5. Enige leerlingraad / sport / kultuur prestasies asook sertifikate, bewyse of motiverings. 6. Bewys van registrasie by Universiteit asook die nuutste uitslae van die Universiteit of

Hoërskool (indien die student nog in Matriek is);

7. FAKTUUR VAN UNIVERSITEIT OF INSTANSIE waarop die student se geskatte fooie en die Universiteit of instansie se bankbesonderhede voorkom.

4. ALGEMENE INLIGTING EN INSTRUKSIES:

E-pos of faks asb die volledige voltooide aansoekvorm na melani@helpendehand.co.za of 086 218 3185. Indien enige inligting op die aansoekvorm onwaar en vals is sal die aansoek summier afgekeur word. Die uitslag van die aansoek en bedrag toegestaan is finaal.

Solidariteit Helpende Hand behou die reg voor om ‘n aansoek om watter rede ookal af te keur.

Indien die student opskop of druip is die volle balans onmiddellik betaalbaar.

GENERAL GUIDELINES

PLEASE NOTE: Insufficient information or misinformation may delay the processing or result in the cancellation of your application. Each section of the application form must be completed in full. NO LATE SUBMITTANCE OF APPLICATIONS WILL BE TOLERATED. 1. REQUIREMENTS:

To apply for a study loan: The applicant must provide proof of psychometric testing; The applicant or his/her family must be a paid-up member or supporter of the Solidarity Movement. You can become a supporter of Helping Hand by giving a donation of R50 per month. Find attached hereto a supporter form.

2. IMPORTANT DATES:

Application forms can be obtained between 2 May 2013 and 30 September 2013 at melani@helpendehand.co.za or telephonically at 012 644 4428, or can be downloaded from our website at www.helpendehand.co.za No outdated application forms must be obtained from the service stations, new application forms can only be obtained through the Bursary Institute at Head Office. E-mail or fax the completed application forms to Melani Gerber at melani@helpendehand.co.za or 086 218 3185. It remains the applicant’s responsibility to ensure that the application form has been received by us. No late applications will be accepted. Students must re-apply annually between 1 May and 30 September for the following year. Current students must also re-apply.

3. DOCUMENTS TO BE ATTACHED:

1. Proof of psychometric testing. You are welcome to make us of Helping Hand’s services in this regard. More information are attached hereto for easy reference.

2. Certified copies of the student and parents’ ID documents; 3. One month’s payslip of both parents or student’s payslip if financially independent. In the

event of no payslips, 3 months’ bank statements should be attached. 4. Proof of highest results obtained, i.e. Matric certificate / NQF certificate or any other

certificate. 5. Proof of prefect / sport achievements and/or any certificate or proof. 6. Proof of registration from the University or Institution in the event of a first year student,

alternatively latest results from the University or High School if the student is still in Matric. 7. Invoice from University or Institution of an estimate of the student’s fees for the year. The

invoice must also contain the University or Institution’s bank details. 4. GENERAL INFORMATION AND INSTRUCTIONS:

4.1 Kindly e-mail or fax the completed application form to melani@helpendehand.co.za or 086 218 3185.

4.2 Should any information on the application form be false, the application will be dismissed. 4.3 The outcome of Solidarity Helping Hand’s decision and the amount allocated is final. 4.4 Solidarity Helping Hand reserves the right to reject an application for any reason

whatsoever. 4.5 In the event where the student fails or drops out, the full balance is payable immediately.

VERKLARING DEUR STUDENT: Ek verklaar hiermee dat al die inligting wat ek in hierdie aansoekvorm verstrek het, waar en korrek is. Ek neem kennis dat my aansoek vir ‘n studielening van Solidariteit Helpende Hand onderworpe is aan al die bepalings en voorwaardes vervat in hierdie skriftelike kontrak. DECLARATION BY STUDENT: I hereby declare that all the particulars given in this application form are true and correct. I also declare that my application for a study loan at Solidarity Helping Hand shall be subject to the terms and conditions contained in this agreement.

VERKLARING DEUR OUER/VOOG: (Indien aansoeker minderjarig is of steeds van sy/haar ouer(s)/voog afhanklik is). Ek aanvaar gesamentlik en afsonderlik aanspreeklikheid vir betaling van alle gelde wat deur die aansoeker teenoor Solidariteit Helpende Hand verskuldig is of mag word, indien die aansoeker sy/haar studies staak of druip. Ek onderneem ook om die skuld te vereffen sodra dit betaalbaar is. As ouer/voog van die aansoeker het ek my op hoogte gestel van die inhoud van die ooreenkoms tussen die aansoeker en Solidariteit Helpende Hand en ek verleen hiermee my goedkeuring aan die sluiting van die ooreenkoms. Ek bevestig dat die bepalings en voorwaardes waaraan die aansoeker in hierdie kontrak onderworpe sal wees in die ooreenkoms vervat is wat tydens aansoek om finansiële steun deur die aansoeker ingevul en onderteken is. Ek waarborg dat, in soverre dit regtens nodig mag wees, die ooreenkoms wat daardie bepalings en voorwaardes bevat met my medewete, toestemming en bystand aangegaan sal word. DECLARATION BY PARENT / GUARDIAN: (If applicant is a minor or still dependent on his/her parent(s)/guardian). I hereby assume joint and several responsibilities with the applicant for the payment of any fees that may fall due to Solidarity Helping Hand, if the applicant does not pass or cancels his/her studies at any time. I undertake to pay all such fees on the appointed due dates. As the applicant’s guardian, I have acquainted myself with the contents of the agreement between the applicant and Solidarity Helping Hand and I hereby grant my approval for entering into the agreement. I confirm that the terms and conditions of the agreement to which the applicant will be subject are contained in the application for financial help that the applicant has signed. I guarantee that insofar as it may be required by law, the agreement containing these terms and conditions is concluded with my knowledge, consent and assistance. Teken / Sign: __________________ _______________________ _______________________ OUER / VOOG STUDENT DATUM / DATE PARENT / GUARDIAN