SAFRIPOL Community Bursary Application Form 2024

SAFRIPOL COMMUNITY BURSARY APPLICATION FORM
Safripol is committed to comply with the regulations as set out in the Protection of Personal Information Act 4 of 2013. In disclosing
your personal details as well as that of your dependent, you hereby acknowledge and agree that you have read and understood the
content of the Safripol Protection of Personal Information Policy. You furthermore consent to the lawful collection, use, disclosure and
storing of this information by the Company for the application of community bursaries only.
A) PERSONAL DETAILS:
APPLICANTS DETAILS:
1. Surname: Mr/Mrs/Miss
2. First names (in full):
3. Date of birth:
4. Residential address: (please attach proof of residence)
5. Postal address:
PARENT/GUARDIAN DETAILS:
6. Dr/Mr/Mrs/Miss: 7. ID No:
(Full names and surname of parent or guardian)
8. Relationship with Student:
9. Address of parent/guardian: 10. Contact no:
11. Employer:
12. Date employed:
13. Are you in possession of another bursary/study loan? Yes No
a) Yes, state name of institution that granted bursary/study loan and the obligation:
b) Bursary amount:
COMPLETE ONLY B.1 OR B.2
B1) QUALIFICATIONS:
1. Matriculation or equivalent examination: CAO no. (if applicable):
a) Name of School: b) Grade 12 Final examination written / to be written

during 20
c) Town / City d) Province:
e) e) Subjects studied and symbols obtained in most recent examination Trials Results:
Applicant should enclose a certified copy of the most recent official matriculation results.
B2) University and other training: Student Number:
a) Degrees / Courses already obtained / passed:
b) At present entered for the degree / course at:
c) Total duration of course semesters/years
b) Present year of study and subjects:
e) When did you commence post matriculation studies?
f) Have you failed any year of study?
g) If so, which year of study and when?
Attach a certified copy of your complete, OFFICIAL Academic Transcript furnishing the annual records / symbols /
percentages obtained in ALL university examinations already written.
C) COURSE OF STUDY
1. Degree / course you intend sitting for and major subjects:
2. Is Grade 12 a prerequisite for the course you intend following? Yes No
3. Are you enrolling for full time or part time study?
4. If part time, state annual income:
5. At which institution do you intend studying?
6. Year in which study commences: Duration of courses : years
D) DECLARATION
I / we declare that the above particulars are complete and correct:
SIGNATURE OF APPLICANT DATE
SIGNATURE OF PARENT / GUARDIAN DATE
FOR OFFICE USE ONLY

☐Approved ☐ Not Approved
Bursary Committee/HR DATE

SUPPORTING DOCUMENTS
REQUIRED DOCUMENT CHECKLIST:
Current Matric Continuing Student
If you are entering your first tertiary academic year, please If you have completed at least 1 year of tertiary study and you
furnish the following documents. have promoted to your next academic year, please furnish the
Please tick the boxes under “Applicant Check” to indicate which following documents.
documents are attached Please tick the boxes under “Applicant Check” to indicate
which documents are attached.
Applicant Office Applicant Office
Document Document
Check Check Check Check
Certified copy of applicant ID Certified copy of applicant ID
Affidavit of Declaration of Affidavit of Declaration of
Dependency to Parent / Guardian Dependency
Certified copy of Grade 11 report Certified copy of Matric
Certificate
Certified copy of latest Grade 12 Certified copy of academic
report* transcript
Acceptance letter from preferred Updated fee statement
tertiary education institution
Proof of income of Parent / Proof of Enrolment for 2024
Guardian / Proof of SASSA academic year
Testimonial from Current High Motivation Letter
School
Proof of residence Proof of residence
*Your final matric results should be forwarded to

SAFRIPOL as soon as it is available
SIGNED at this day of 20
AS WITNESS:
BURSARY APPLICANT
AS WITNESS:
Assisted by PARENT / GUARDIAN / TRUSTEE
Completed application and required documents to be e-mailed to bursary@safripol.com before 30 November 2023

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SAFRIPOL COMMUNITY BURSARY APPLICATION FORM

2. First names (in full):

4. Residential address: (please attach proof of residence)

8. Relationship with Student:

9. Address of parent/guardian: 10. Contact no:

12. Date employed:

13. Are you in possession of another bursary/study loan? Yes No

COMPLETE ONLY B.1 OR B.2

a) Name of School: b) Grade 12 Final examination written / to be written

c) Town / City d) Province:

a) Degrees / Courses already obtained / passed:

b) At present entered for the degree / course at:

c) Total duration of course semesters/years

b) Present year of study and subjects:

e) When did you commence post matriculation studies?

f) Have you failed any year of study?

g) If so, which year of study and when?

1. Degree / course you intend sitting for and major subjects:

2. Is Grade 12 a prerequisite for the course you intend following? Yes No

3. Are you enrolling for full time or part time study?

4. If part time, state annual income:

5. At which institution do you intend studying?

6. Year in which study commences: Duration of courses : years

I / we declare that the above particulars are complete and correct:

SIGNATURE OF APPLICANT DATE

SIGNATURE OF PARENT / GUARDIAN DATE

FOR OFFICE USE ONLY

Bursary Committee/HR DATE

REQUIRED DOCUMENT CHECKLIST:

Current Matric Continuing Student

*Your final matric results should be forwarded to

SIGNED at this day of 20

Assisted by PARENT / GUARDIAN / TRUSTEE

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