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ITHALA EDUCATION FUNDAPPLICATION FORM

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APPLICATION FORMITHALA EDUCATION FUND

ITHALA EDUCATION FUND (IEF) APPLICATION FOR REGISTRATION FEE FUNDING

SECTION 1: GENERAL INFORMATION

CLOSING DATE FOR APPLICATIONS: 30 NOVEMBER 2017

APPLICATION INSTRUCTIONS AND CRITERIA

REFERENCE: IEF 2018 ITHALA EDUCATION FUND Ithala SOC Limited Head Office303 Dr Pixley KaSeme (West) Street, 15th Floor, Delta TowersPO Box 2588, Durban, 4001

Email Applications can be sent to: educationfund@ithala.co.za

PLEASE READ EVERY SECTION OF THE APPLICATION FORM AND FULLY COMPLETE ALL REQUIRED SECTIONS. Provide all required supporting documents as these form an important part of our selection process. Application forms without ALL supporting documents will not be processed by IEF. IEF requires that you provide working contact details, a cellphone number or an email address where you can be contacted to provide you updates during the application process.

IEF CONTACT DETAILS:T: +27(0)80 133 1130 | E: educationfund@ithala.co.za | W: www.myithala.co.za or Facebook/Twitter @Myithala

Application for Ithala Education Fund Registration Fee Funding for First Year students.Please return the completed form with supporting documents to:

1. Please ensure that this form is completed in full and signed.2. Complete in BLOCK LETTERS and black ink.3. IEF is for first year registration fees and cannot be used for any other purpose.4. Incomplete and late applications will be disqualified.5. Applications are only open to first year South African citizens who meet the IEF selection criteria.

Please read this section carefully before completing this form1. Please note that even if you may be eligible for IEF registration funding, we advise you to also apply for other bursaries/student

loans, as your application to IEF does not guarantee acceptance.2. Only applicants who meet the IEF funding criteria will be considered for funding. 3. Information and supporting documentation required will ONLY be used for the purpose of assessing the financial eligibility of applicants.4. The information may be shared with third parties including credit bureaus and other agencies for the purposes of information

validation, criminal checks and to verify previous academic records.5. By completing this application form you consent for IEF to use the information you provide for all necessary purposes of assessing

your application including but not limited to those in point 4 above.

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REQUIRED SUPPORTING DOCUMENTS

1. Certified copy of a valid South African Identity Document/card.2. Certified copy of unabridged birth certificate (if you do not have a green bar-coded ID or ID card)3. Certified copy of ID of each parent or legal guardian. 4. Certified copy of a valid Senior Certificate (if you have completed Grade 12).5. Certified copy of the latest academic results.6. A copy of your proof of residence.7. Certified copy of each parent’s or legal guardian’s latest payslip or proof of income (if parent/s or legal guardian are not working

provide a SWORN AFFIDAVIT from the South African Police Service (SAPS).8. Proof of acceptance from the University or TVET College you wish to study at, on official University/TVET college letterhead.

NOTE: All certified copies MUST NOT be older than three months.

SECTION 2: APPLICATION FORM

PART A: DETAILS OF APPLICANT

Please provide names and ID number as per ID document. The stamp on your certified ID copy should not be older than 3 months and must be on the same side as the image of the ID.

Surname

First Names

ID Number

Street Addresses

Province

Suburb/Village

Cellphone

Postal Address

Postal Code

District Municipality

Local Municipality

Ward Number

Local Councillor

City/Town

Postal Code

Email( )

APPLICATION FORMITHALA EDUCATION FUND

First Choice:

TVET College or University Faculty

Planned Qualification (Full Name)

Level/Year of study First IEF offers registration fees for first year only

Second Choice:

TVET College or University Faculty

Planned Qualification (Full Name)

Level/Year of study First IEF offers registration fees for first year only

Third Choice:

TVET College or University Faculty

Planned Qualification (Full Name)

Level/Year of study First IEF offers registration fees for first year only

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Do you have any other form of financial assistance for your studies? Yes No

Type Bursary Loan

Amount

Do you have a disability? Yes No

What is your preferred way to contact you? SMS Email

Do you receive an SASSA grant? Yes No

Race African Asian Coloured Indian White

Have you ever been declared mentally unfit by a court of law? Yes No

Name of last School you attended

PART B: DETAILS OF YOUR CURRENT/MOST RECENT STUDIES

PART C: DETAILS OF YOUR PLANNED STUDIES IN 2017

Please provide a copy of your latest/most recent academic results

Planned qualifications (please list three choices for University/TVET College study in 2017)

In School

Gr 9 - 11

Employed

Gr 12

Unemployed

Other

Studying & not employed Studying & employed

What are you doing this year?

Highest Academic Level Achieved

APPLICATION FORMITHALA EDUCATION FUND

DisclaimerBy signing this application form, I accept and understand that this application does not guarantee that I will receive Ithala Education Funding for registration fees. If I am not successful, I will be responsible for all required registration fees at the university/college. I understand that any false information provided as part of my application may lead to disqualification of my application. I understand that if my application is successful, the registration fees will be paid directly to the University or TVET College and that should the registration fee funding be withdrawn for whatever reasons, I will then be liable for paying the registration in full. I also give IEF permission to validate the information I have provided with third parties for the purpose of processing my application and that such information should be used for this purpose only and be treated with utmost confidentiality.

Signature of applicant

Date

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APPLICATION FORMITHALA EDUCATION FUND

PART D: CHECKLIST TICK IF INCLUDED

Proof of acceptance from the University or TVET College you wish to study at on official University/TVET college letterhead

Certified copy of a valid South African Identity Document/card NOT older than three months

Certified copy of unabridged birth certificate (if you do not have a green bar-coded ID or ID card) NOT older than three months

Certified copy of ID of each parent or legal guardian NOT older than three months. If either of your parents is deceased, please provide a certified copy of the death certificate.

Certified copy of ID of each of your household members living with you NOT older than three months

Certified copy of a valid Senior Certificate (if you have completed Grade 12) NOT older than three months

Certified copy of the latest academic results NOT older than three months

A copy of your proof of residence NOT older than three months

Certified copy of each parent’s or legal guardian’s latest payslip or proof of income (if parents or legal guardian are not working, provide a SWORN AFFIDAVIT from the South African Police Service (SAPS) NOT older than three months. Note: All sources of income including SASSA grants must be included. Failure to disclose may lead to your application being disqualified.

Ithala is an Authorised Financial Services and Credit Provider. FSP License No. 17139 NCRCP No. 1559 Reg No. 2001/007/427/30.Ithala SOC Limited is a wholly-owned subsidiary of Ithala DevelopmentFinance Corporation Limited. Ts&Cs apply. E&OE.