Aansoekvorm 2015

AFRIKAANSE BEURSINSTITUUT:STUDIELENING AANSOEKVORM
2015
(Aansoeke vir studielenings open op
2 Mei 2014 en sluit stiptelik op 30 September 2014)
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 een van die volgende inisiatiewe van die Solidariteit Beweging?
Are you currently a member or supporter of one of the following initiatives of the Solidarity Movement?
(Merk met ‘n “x” / Mark with an “x”)
Solidariteit / Solidarity:
Afriforum:
Helpende Hand / Helping Hand:
Solidariteit Lidnommer:
Solidarity Membership number:
Afriforum Lidnommer:
Afriforum 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?
JA / YES
NEE / NO
STUDENT SE BESONDERHEDE
STUDENT’S DETAILS
Studentenommer:
Student nr:
Noemnaam:
Name:
Mej/Mev/Mnr:
Miss/Mrs/Mr:
Voorletters:
Initials:
Ouderdom:
Age:
Van:
Surname:
Is u gestremd?
Are you disabled?
Studierigting:
Study field:
Instansie / Universiteit:
Institution / University:
Wat doen jy tans?
1ste jr
What are you currently doing? 1st yr
2de jr
2nd yr
3de jr
3rd yr
4de jr
4th yr
Nagraads
Post graduate
Het jy ŉ psigometriese toets gedoen?
(verpligtend vir eerstejaars maar kan deur ander studente ook ingedien word)
Did you undergo psychometric testing?
(compulsory for first year students but can be submitted by any other student)
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?
Gr 12
Taalvoorkeur:
Language:
Huwelikstatus:
Marital status:
E-pos adres:
(verpligtend)
E-mail address:
(compulsory)
Afhanklikes:
Dependants:
Faksnommer:
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./ bv. Steve Booysen /
Arend J de Kock / Solidariteit Opleidingstrust ens)
Posadres:
Postal Address:
Selfoonnr:
Cell:
Poskode:
Postal code:
Huis:
Home:
Woonadres:
Residential
Address:
Poskode:
Postal code:
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
(Let wel dat Lewensoriëntering nie in aanmerking geneem word nie)
(Please note that Life Orientation will not be taken into consideration)
1.
% 3.
% 5.
%
2.
% 4.
% 6.
%
STUDENT SE GADE (indien van toepassing)
STUDENT’S SPOUSE (if applicable)
Noemnaam:
Name:
Van:
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:
Postal Address:
Werkgewer:
Employer:
Poskode:
Postal code:
Werk telefoonnommer & kode:
Work telephone number:
Selfoonnommer:
Cell:
VADER VAN STUDENT
STUDENT’S FATHER
Van:
Surname:
Voorl:
Initials:
Naam:
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:
Postal Address:
Werkgewer:
Employer:
Poskode:
Postal code:
Werk telefoonnommer & kode:
Work telephone number:
Selfoonnommer:
Cell:
Getroud:
Married:
Ongetroud:
Not married:
Ongetroud maar woon saam met lewensmaat:
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:
Surname:
Voorl:
Initials:
Naam:
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:
Postal Address:
Werkgewer:
Employer:
Poskode:
Postal code:
Werk telefoonnommer & kode:
Work telephone number:
Selfoonnommer:
Cell:
Getroud:
Married:
Ongetroud:
Not married:
Ongetroud maar woon saam met lewensmaat:
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 slegs die besonderhede
van die ouer wie in die kind se behoeftes voorsien, gemeld te word.
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:
Surname:
Telefoonnommer / Cell:
Verwantskap / relationship:
Voorl:
Initials:
E-pos / e-mail adres:
Naam:
Name:
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.
2.
3.
4.
5.
Die mees onlangse salarisstrokie van beide ouers;
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;
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;
In die geval van werkloosheid moet ‘n verklaring deur die werklose persoon afgelê word
wat dit bevestig.
‘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.
2.
3.
4.
5.
The most recent payslips of both parents;
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;
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;
If unemployed, an affidavit must be attached in which the unemployed person affirm same.
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 provides for the household?
GESINSBESONDERHEDE
FAMILY DETAILS
Lys alle permanente inwonende gesins- en familielede in jou huis wat afhanklik is van die
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
In watter kategorie val hy/sy?
In which category does he/she
fall?
Volwassene
Adult
Ouderdom:
Age:
Student
Verwantskap:
Relationship:
Skolier
Scholar
Van:
Surname:
Voorskool
Pre-school
Voorletter:
Initials:
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 (verpligtend vir eerstejaars maar
ander studente kan ook bewys lewer)
 ŉ Lid wees van Solidariteit of Afriforum, of ‘n ondersteuner van Solidariteit Helpende
Hand.
Word vandag nog ŉ ondersteuner van Helpende Hand deur ŉ vrywillige bydrae van R50 per
maand te maak. http://helpendehand.co.za/sluit-aan-in-een-minuut/
2.
BELANGRIKE DATUMS:
Aansoekvorms kan vanaf 2 Mei 2014 tot 30 September 2014 aangevra word by Melani Gerber
by [email protected] en/of by Yolandi Theron by [email protected] 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: [email protected] of 086 218 3185; en/of
Yolandi Theron: [email protected] of 086 292 5061.
Dit bly die aansoeker se verantwoordelikheid om te verseker dat ons die aansoekvorm
ontvang het.
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.
4.
DOKUMENTE WAT HIERBY AANGEHEG MOET WORD:
1.
Bewys van psigometriese toets afgelê (in die geval van eerstejaars). U is welkom
om van Helpende Hand se psigometris gebruik te maak. Inligting van Helpende Hand se
psigometris kan verkry word deur ŉ e-pos te stuur aan [email protected] /
[email protected] of kyk gerus op www.medpages.co.za vir u naaste
psigometris.
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
van die AFGELOPE JAAR.
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.
ALGEMENE INLIGTING EN INSTRUKSIES:
E-pos of faks asb die volledige voltooide aansoekvorm na [email protected] of
086 218 3185 of na [email protected] of 086 292 5061.
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 Solidarity/Afriforum member or
Helping Hand supporter. You can become a supporter of Helping Hand by
donating R50 per month.
2.
IMPORTANT DATES:
Application forms can be obtained between 2 May 2014 and 30 September 2014 at
[email protected] and/or [email protected] 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 [email protected]
or 086 218 3185 or to Yolandi Theron at [email protected] or 086 292 5061.
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 other certificate or proof of the LAST
YEAR.
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
4.2
4.3
4.4
4.5
Kindly e-mail or fax the completed application form to [email protected] or
086 218 3185 or to [email protected] or 086 292 5061.
Should any information on the application form be false, the application will be dismissed.
The outcome of Solidarity Helping Hand’s decision and the amount allocated is final.
Solidarity Helping Hand reserves the right to reject an application for any reason
whatsoever.
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
PARENT / GUARDIAN
_______________________
STUDENT
_______________________
DATUM / DATE