BERGRIVIER MUNICIPALITY EXTERNAL PERSONAL DETAILS OF APPLICANT Surname First Name Date of Birth Identity Number Student Number(If available) Equity Group (Mark appropriate block anX) Black Coloured Indian White Disability (pleaseprovide proof) Home Language Marital Status Home Address Code Home Tel Number Cell Number E-mail address Qualification PARENT/GAURDIAN DETAILS Name andSurname ofFather Name andSurname ofMother ID Number ofFather ID Number ofMother Address OCCUPATION Father Mother Guardian QUALIFICATION Indicate current or intended course which you will be studying towards in2023(e.g. National Diploma: Human Resources, BA, B Com (Accountancy) Name of Institution: LEVEL OF STUDY Description Definition Mark appropriate block with an X 1st Year Student You will beenrolling forthe first time atinstitution Senior Student You arecontinuing(i.e. 2nd or 3rdyear) Final year student You will writeyour finalexamination inNovember tograduate thefollowing year Post GraduateStudent You will beregistered forqualification inthe year ofapplication FUNDING Please provide a quotation of the actual cost of your studies. SIGNATURE OF APPLICANT DATE SIGNATURE OF PARENT/GUARDIAN DATE NOTES AND INSTRUCTIONS FOR COMPLETION  INCOMPLETE APPLICATION FORMS WILL NOT BE ACCEPTED (this includes forms with missing documents);  No late submissions will be accepted;  The municipality does not accept responsibility and will not be held liable for any applications which were undelivered or missing;  E‐mailed applications will not be accepted;  The closing date for applications is 27 October 2023;  Only full time students studying towards a degree/ diploma at a Tertiary Institution may apply;  A senior student must have passed the previous year’s studies to qualify for a bursary; Please attached the following documents:  Mark appropriate block with an X Prescribed bursary application form Proof of disability (if applicable) Certified copy of South African identity document Proof of monthly household income (salary or pension slip if applicable, affidavit if unemployed.) Proof of residence with Bergrivier municipal area #J-18808-Ljbffr