BERGRIVIER MUNICIPALITYEXTERNALPERSONAL DETAILS OF APPLICANTSurnameFirst NameDate of BirthIdentity NumberStudent Number(If available)Equity Group(Mark appropriate block anX)Black Coloured Indian WhiteDisability (pleaseprovide proof)Home LanguageMarital StatusHome AddressCodeHome Tel NumberCell NumberE-mail addressQualificationPARENT/GAURDIAN DETAILSName andSurname ofFatherName andSurname ofMotherID Number ofFatherID Number ofMotherAddressOCCUPATIONFatherMotherGuardianQUALIFICATIONIndicate 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 STUDYDescription Definition Mark appropriate block with an X1st Year Student You will beenrolling forthe first time atinstitutionSenior Student You arecontinuing(i.e. 2nd or 3rdyear)Final year student You will writeyour finalexamination inNovember tograduate thefollowing yearPost GraduateStudentYou will beregistered forqualification inthe year ofapplicationFUNDINGPlease provide a quotation of the actual cost of your studies.SIGNATURE OF APPLICANTDATESIGNATURE OF PARENT/GUARDIANDATENOTES 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