Identity number

Are you employed?

If yes, please state the sponsor

State your highest qualification eg Grade 12, B. Degree, N. Diploma or Postgraduate Degree

Name of institution

Year of completion

Undergraduate Postgraduate

Application schedule

Semester 1: 1 August – 19 September 2013

Semester 2: 1 April 2014 – 18 April 2014

Postgraduate funding applicantions 1 August 2013 – 10 February 2014

1 Personal particulars

2 Employment details

If yes, please complete section 2.1. If no, please complete sections 3 or 3.1.2.1 Applicant’s employment details (attach certified proof of income not older than three months)

Name of employer

Address

Tel number

Salary Wages Other Monthly

Weekly

Student no

Yes

Marital status: Single Married If married Widowed Divorced

In community of property

Antenuptial contract (ANC)

Prenuptial contract (PNC)

Yes

No

Are you under financial administration order (insolvency) for unpaid debt? Yes No

Do you have any other form of funding? Yes No

Prison student If yes, please attach the prisoner’s profile from authorities indicating term of sentence, years already served and remaining years to be servedYes No

Have you been declared mentally unfit by a court of law to enter into any legal agreement? Yes No

2014 Student Funding Application Form Undergraduate/Postgraduate Studies ONLY South African citizens are eligible for NSFAS offerings

*Only one application per academic year

*Please supply us with an applicable certified copy: marriage certificate, ANC, PNC, death certificate (widowed), divorce decree

i

File no (for office use only)

Section J

*If married please complete section 3.1 with spouse’s employment details

Yes

Title Initials SurnameMr Mrs Ms

FOR OFFICE USE ONLY

Student’s income Number of lawful H/H Number of tertiary students

Gross income 1 Remaining term of sentence Screened by

Gross income 2 Comments:

3 Details of parent/s for a dependant’s application • PleaseattachcertifiedcopiesofID,deathcertificateordivorcedecree.Ifoneorbothparentsareunknown, the guardian must confirm this in an affidavit (not the student). • Pleaseattachlatestpayslipifemployed,last3months’bankstatementsandanaffidavitifself-employedorunemployed.

3.1 Legal guardian/spouse (please attach latest payslip if employed, last 3 months’ bank statements and an affidavit if self-employed or unemployed)

4 Particulars of next of kin: mother, father, sister, brother, cousin, partner, aunt or uncle

Surname Initials Title

Relationship to applicant (Girlfriend or boyfriend not acceptable)

Postal address

Telephone number Cell number

ii

Name Surname ID number Relationship to applicant (1) Age Currently busy

with (2)

5 Particulars of lawful household (eg parent/s, guardian, other dependents starting with applicant):• NB:Pleaseuseaseparatepageifspaceprovidedbelowisinsufficient• AttachcertifiedcopiesofRSAidentitydocumentsorbirthcertificatesofallmembersoflawfulhousehold

(1) Spouse/partner/brother/sister/daughter/son/uncle/aunt/grandparent/other(2) Primary school/secondary school/out of school/unemployed/employed/university (of technology)/FET college/other*Please attach certified copies of proof of income for employed members of household stated in section 5, excluding members already mentioned in sections 3 and 3.1.

6 DeclarationI declare that I have read and understood the contents of this loan application form, and information supplied by me is true and correct. I also understand that should any of the information/documents herein be proved to be incorrect or falsified, disciplinary action will be taken against me.

7 Faxed application forms will not be accepted. Hand deliver to any Unisa’s Regional Office or Post to Division Student Funding, P.O.Box 392, Unisa 003

----------------------------------------------------------------- --------------------------------------------------------------------------Student’s signature Date

----------------------------------------------------------------- --------------------------------------------------------------------------Parent/guardian’s signature (if student is under 18) Date

Father Mother

Name & Surname

ID Number

Residential address:

House No and Street Name

Suburb

City and Code

Name of employer

Employer’s address

Tel number

Salary Wages Other Monthly

Weekly

Name & Surname Name of Employer

ID Number Work address:

Residential address:

House no and Street Tel Number

Suburb Salary Wages Monthly

City and code Weekly