High_Education_Should_Be_Funded

BURSARY NO.: (For official use only) APPLICATION FOR A BURSARY TO STUDY FOR THE LL.B DEGREE PLEASE NOTE: 1. COMPLETE FORM IN TYPED OR PRINTED WRITING 2. IT IS TO YOUR BENEFIT THAT THIS FORM BE COMPLETED AS COMPREHENSIVELY AS POSSIBLE 3. NOTE THE REQUIRED ANNEXURES (SECTIONS “B.3” AND “F.5”) 4. ATTACH A CERTIFIED COPY OF YOUR IDENTITY DOCUMENT OR PROOF OF PERMANENT RESIDENCY STATUS ATTACH PASSPORT SIZE PHOTOGRAPH SECTION ‘A’ – PERSONAL PARTICULARS SURNAME FULL FIRST NAMES GENDER (Male or Female) RACE (Black, Coloured, Indian, White) DATE OF BIRTH IDENTITY NUMBER (Attach A Certified Copy) CITIZENSHIP (If You Are Not A S.A. Citizen, Please Attach A Certified Copy of Your Permanent Residence in S.A.) MARITAL STATUS DEPENDENT CHILDREN (State Ages) Office +27 (0) 21 424 5351 Fax +27 (0) 21 423 4819 Email attorneys@fidfund.co.za Website www.fidfund.co.za Physical 5th Floor, Waalburg Building, 28 Wale Street, Cape Town, 8001, South Africa Postal P O Box 3062, Cape Town, 8000, South Africa Docex Docex 154, Cape Town B M Molefe (Chief Executive Officer), A M Stansfield (Finance Executive), J M Losper (Claims Executive), J B de Beer (Forensic Executive) P Z Ndima (Senior Claims Manager), R Burawundi (Investment Manager), S D Maile (Board Secretary) BUSINESS ADDRESS Postal Code : BUSINESS TEL. NUMBER RESIDENTIAL ADDRESS Postal Code : HOME TEL. NUMBER CELLPHONE NUMBER E-MAIL ADDRESS POSTAL ADDRESS (Address where correspondence must be sent to) Postal Code : 2 SECTION ‘B’ – ACADEMIC QUALIFICATIONS 1. DEGREES OR DIPLOMAS OBTAINED DEGREE/DIPLOMAS UNIVERSITY 1.1 1.2 1.3 1.4 1.5 2. YEARS COMPLETED OF 4-YEAR LL.B CURRICULUM UNIVERSITY 2.1 First Year 2.2 Second Year 2.3 Third Year 2.4 Fourth Year 2.5 What year of study are you in now' 2.6 How many years of study do you still need to complete your LL.B' 3. DATE OF AWARD YEAR COMPLETED RECORD: PLEASE ATTACH OFFICIAL TRANSCRIPT OF YOUR ACADEMIC RECORD, UNTIL THE END OF THE FIRST SEMESTER OF THIS YEAR SECTION ‘C’ - PROFESSIONAL PARTICULARS 1. HAVE YOU BEEN ADMITTED AS AN ATTORNEY 2. PRESENT POSITION 3. NAME OF EMPLOYER/FIRM YES NO 3. ADDRESS OF EMPLOYER/FIRM SECTION ‘D’ – PROPOSED COURSE OF STUDY 1. At which university or institution do you propose to study for the LL.B degree 2. Please provide us with your student number for the above university or institution 3. Please indicate, as precisely as possible, the FROM TO period during which you will undertake your _____/____/20_____ _____/______/20____ studies 3 1. Period applied for SECTION E : GRANT APPLIED FOR (please tick) 1 YEAR 2 YEARS 2. Amount needed in respect of tuition fees for 1 year of study ONLY : SECTION ‘F’ – GENERAL 1. Did you obtain leave from your employer for the proposed period of study YES NO 2. If leave was obtained, will it be paid or unpaid leave PAID UNPAID 3. If you have been awarded other financial assistance, please indicate the name of grantor and the amount awarded: 3.1 R 3.2 R 3.3 R 4. If you have applied for other assistance and are still awaiting the outcome, please indicate to whom you have applied and the amount for which you have applied. 4.1 R 4.2 R 4.3 R 4.4 R 5. REFERENCES: ATTACH at least ONE RECENT TESTIMONIAL BY THE DEAN of your Faculty of Law (or his assignee). The testimonial must, IN ALL INSTANCES, refer to your academic record and, in case of applications based on serious financial need, testify as to your ability to complete the LL.B degree within the prescribed period. SECTION ‘G’ – FINANCIAL DETAILS 1. APPLICANT’S PARENTS (Assets & Liabilities) 1.1 ASSETS 1.1.1 Fixed property (market value) 1.1.2 Motor vehicles 1.1.3 Savings/investments 1.1.4 OTHER (Specify) TOTAL ASSETS 1.2 LIABILITIES 1.2.1 Bond over fixed property 1.2.2 Balance owing on vehicle(s) 1.2.3 Overdraft 1.2.4 Amount owing on credit card 1.2.5 OTHER (Specify) TOTAL LIABILITIES R R R R R R R R R R R 4 2. APPLICANT (Income and expenditure) 2.1 INCOME (per year) 2.1.1 Salary during study period 2.1.2 Other financial assistance (Section ‘F.3’ above) 2.1.3 Assistance from parents 2.1.4 OTHER (Specify) R R R R TOTAL INCOME 2.2 3. EXPEDITURE (total of Section ‘E’) Do you possess a motor vehicle or other loose assets' Please provide details: R R PLACE: ____________________________ DATE : ____________________________ SIGNATURE: ________________________ SUMMARY FOR OFFICE USE ONLY 1. NAME 2. ACADEMIC QUALIFICATIONS 3. PROPOSED DEGREE 4. UNIVERSITY 5. PERIOD OF STUDY 6. FOR YEARS FIRST YEAR 20__________ 2ND YEAR 20__________ 5 CHECKLIST 1. Have you attached your passport size photograph to the application form' 2. Are you a South African Citizen' If not, have you attached a certified copy of your permanent residence in South Africa' 3. Have you attached a certified copy of your identity document' 4. Have you attached your official transcript of your academic record, until the end of the first semester of this year' 5. Have you attached a recent testimonial by the Dean of your Faculty of Law or his assignee' 6. Have you signed and dated your application' 7. Is this the original application form' We do not accept faxed or e-mailed application forms, please post or hand deliver your original application form. IF YOU DO NOT ATTACH THE ITEMS LISTED ABOVE, YOUR APPLICATION FORM WILL BE INCOMPLETE. THE INCOMPLETE FORM WILL BE RETURNED TO YOU AND IT WILL NOT BE SUBMITED TO THE BURSARY COMMITTEE UNTIL ALL THE NECESSARY INFORMATION IS PROVIDED. Kindly direct all queries to : Liesel Decker on 021 - 424 0711 or e-mail to : liesel@fidfund.co.za eeshawn@fidfund.co.za Shawn Africa on 021 - 424 4608 or e-mail to : shawn@fidfund.co.za 6