APPLICATION

FORM

2024 SCHOLARSHIP
PROGRAMME
OPEN TO:

GRADE 6
LEARNERS

APPLICATION
DEADLINE:

16 SEPT 2024,
17:00 SAST

SMALL STEPS TO BIG IMPACT 3 JUN - 16 SEP

 Cultivating Entrepreneurship Entrepreneurial Opportunity

Scholarship Application Form 2024

For high school placement in 2026
MINIMUM REQUIREMENTS
Completing Grade 6 in 2024
The Scholarship opportunity is an entrepreneurial programme not only for financial support at high school
Applicants must show interest in becoming an entrepreneur / business owner

Applicant must obtain a minimum of 70% for Mathematics and English in Grades 5 and 6

Clearly demonstrate financial need (Household income must not exceed a monthly gross income of R20 000
)

Failure to provide all the financial documentation will result in your application being disqualified

South African citizen (One parent must be a South African Citizen)

Candidates must not be older than 12 years of age and not younger than 11 years of age in grade 6
(Candidates must be born in 2012 or 2013)

Certified copies of ALL required documentation

Active cellphone number for SMS notifications of application status

Please submit using the information below. Should you have any queries please contact the call centre
on 021 481 5479 (CPT) or 011 290 4940 (JHB)

SELECTION PROCESS
Application
form Write an
Exam Interview

June - 16 September 2024 December 2024 February - March 2025

SUBMISSION DETAILS
Please ensure that this document is signed in full or your application will be disqualified.

POSTAGE: OR HAND DELIVERY: APPLICATION DEADLINE:

Allan Gray Orbis Foundation, 16 September 2024
Freepost no:

Applications posted on or before the

16th of September will be accepted.
Any applications received from
postage after the 1 November will not
be accepted. Applications delivered after the 16th of September
will not be considered
TIP: Register your mail so you can
track it to avoid the application form
from being lost. Page 1 of 13
Please ensure that the following documents accompany this application form:

Divorced parents to provide divorce decree

Legal Guardian to provide proof of legal guardianship

Certified copy of Grade 6 (2nd term) report

If Employed: Certified copy of proof of income of both parents/legal guardian(s);
latest payslips AND 3 months bank statements.
If Self-Employed: Certified Copy of Income tax statements AND 6 months business
account bank statements. Failure to submit statements, application will be disqualified.
If Unemployed: original affidavit(s), stating reasons and period of unemployment.
Should you be receiving a pension income, please provide a certified copy of your pension
income AND 3 months bank statements.

Please complete every section in full

!

!
! Failure to submit all required documentation information will lead to disqualification.
! Refusal to attend an interview and the home visit will lead to disqualification.
! Allan Gray Orbis Foundation does not solicit funds from candidates
! Please include details of biological parent(s) even if you do not live with them
! All information requested by the Allan Gray Orbis Foundation will be kept confidential. The Foundation will not
disseminate any personal information unless specifically authorised on page 7 and page 10 of this application

(Please note, it is compulsory to complete every section of the form in full)

Do you have any learning barriers or disabilities, whether physical or other? Y N ..................................................................................................

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(Information about the parent/legal guardian

MOTHER is required whether actively involved or not)

FATHER (Information about the parent/legal guardian

is required whether actively involved or not)

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(Should we need to contact you urgently. Add a valid email address for communication)

Principal’s Details:

School District:

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Please ensure that proof of income is attached to this application before submitting it to us for processing. Failure to provide this
will result in the automatic disqualification of the applicant. If any of the applicant’s Parents/Guardians is unemployed, an original
affidavit and 3 months bank statements MUST accompany this application, stating reasons for, and period of unemployment.
If a pensioner, please include affidavit as proof.

Combined monthly household income of parent(s) and / or guardian(s) before deductions:

Level of Education

Estimated Market Value of Property: [Compulsory: Please tick the relevant box]

R0 - R250 000 R250 000 - R500 000 R500 000 - R1000 000 > R1000 000 (above)

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8.3 Number of Family Members Dependant on Family Income and Living in the Home
(Start with Applicant’s name - Do not include parents/guardians)

Name Relationship Employed

Age Occupation Income
(sister/aunt etc.) (Yes/No)

1.

2.

3.

4.

5.

8.4 Loans/Debt/Credit Commitments (including retail accounts)

8.5

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Please ensure that a certified copy of the applicant’s Grade 5 (4th term) report and Grade 6 ( 2nd term) report accompanies
this Application Form. The reports must reflect the name and grade of the applicant as well as the name of the School. Failure
to submit this documentation will result in the automatic disqualification of the applicant.

2026

It is therefore crucial that parents/legal guardian(s) provide us with a cellphone number AND a valid email address
in order to facilitate this communication.
Faxed and/or emailed copies of the application form will NOT be accepted.

16th September 2024

I hereby warrant that all the information and documents supplied as part of the application are true,correct complete and
up to date. I authorise all persons or entities to provide any relevant information in their possession to the Allan Gray Orbis
Foundation or its agent for use in considering me for admission or verifying my credentials for admission, and I expressly
waive any required notice to me. I understand and agree that any misrepresentation or omission of facts in my application
will justify denial of admission, the cancellation of admission, or expulsion.

I hereby confirm that I have read and understood the Application Privacy Policy and consent document attached hereto as
Annexure A and Consent to the processing of my Personal Information for the purpose set out in the Annexure.

This application is my own, honest statement to the Scholarship Selection Committee. The decision whether or not to grant the
Allan Gray Scholarship is entirely at the discretion of the Foundation. The Foundation is not obliged to give any reasons for
deeming any applications unsuccessful.

In order for your application to be considered, please ensure that this document is signed in full.

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11. PLACEMENT SCHOOLS

Possibility of Boarding
This opportunity includes the possibility of boarding. It would therefore be beneficial for you to commence discussions with the
applicant about going to a boarding school. Furthermore, every effort is made to place our Scholars at a Placement School
within their home province. However, the number of spaces available in the Foundation is limited. The Foundation reserves the
right to recommend a school for placement of Candidate.

Please discuss the possibility of boarding with the applicant.

12. PARTNERSHIPS
The Allan Gray Orbis Foundation (AGOF) proudly partners with like-minded, value-driven organisations. Together, these partners
and AGOF offer a range of customised scholarships with additional selection criteria. By completing this application form, you will
automatically form part of the internal selection pool from which suitable candidates will be identified. Should you qualify for one
of these partnership scholarships, we will notify you.

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ANNEXURE A: SCHOLARSHIP APPLICATION PRIVACY AND CONSENT

1. INTRODUCTION
In order to consider the scholarship application and where a scholarship is granted, to process the application, Allan Gray
Orbis Foundation will need to receive, collect, use, disclose, record, organise, and store (collectively “Process”) certain personal
and special personal information of the Applicant and his/her Parents/Guardians.

2. INFORMATION PROCESSED
The following personal and special personal information (collectively “Personal Information”) of the Applicant and the
Parents/Guardians of the Applicant may be processed for the purposes set out in 3 -

2.1 race, gender, marital status, colour, age, language and birth; and culture;
2.2 information relating to educational, financial and employment history;
2.3 identity number, e-mail, physical and postal address, contact numbers, student number, welfare/grant/temporary
residence number, immigration status and pension numbers or codes, medical aid number;
2.4 login and user names;
2.5 correspondence (physical or digital) sent by the Applicant and/or Parents/Guardians of the Applicant to Allan Gray Orbis
Foundation or via Allan Gray Orbis Foundation or to a third party and included Allan Gray Orbis Foundation in the
correspondence;
2.6 correspondence (physical or digital) about the Applicant and/or the Parents/Guardian of the Applicant received by the
Allan Gray Orbis Foundation from a third party;
2.7 the views or opinions of another individual about the Applicant, such as performance appraisal details and reports;
2.8 information about a disability
2.9 photograph’s and video recordings.

3. PURPOSE OF PROCESSING
3.1 To consider applications for scholarship
3.2 To process successful applications
3.3 To verify information and documentation submitted with the Application
3.4 For Applicant assessment
3.5 Research
3.6 To manage the Allan Gray Orbis Foundation’s relationship with an Applicant once a scholarship has been awarded by,
for example, tracking academic progress and inviting the Applicant to functions and activities organised by the Allan Gray
Orbis Foundation.
3.7 Photographs and videos of the Applicant will be used for marketing purposes, including being included in internal and
external publications and on the Allan Gray Orbis Foundation website.
3.8 Allan Gray Orbis Foundation may disclose Personal Information to law enforcement, other government officials, or other
third parties as Allan Gray Orbis Foundation in its sole discretion, believes is necessary or appropriate in connection with
an investigation of fraud, intellectual property infringements, or other activity that is illegal or may expose Allan Gray
Orbis Foundation to legal liability.
3.9 Information relating to race, gender and nationality is required in order for Allan Gray Orbis Foundation to comply with
South African laws relating to transformation.
3.10 Personal Information may be disclosed to third parties and third party service providers (including in offshore
jurisdictions) for the purposes set out in 3.1 to 3.7.
3.11 Should an application be declined, Allan Gray Orbis Foundation may continue to use the Personal Information for
research and statistical purposes and in its marketing material.

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4. FOR HOW LONG WILL THE PERSONAL INFORMATION BE KEPT?

The Personal Information will only be retained for such period as is necessary for achieving any of the purposes set out in 3.

5. ACCESS TO PERSONAL INFORMATION

You may request a copy of the Personal Information that Allan Gray Orbis Foundation holds about you. If you would like a copy
of such Personal Information, please contact scholarship@allangrayorbis.org

6. PRIVACY AND CONSENT

The Foundation forms part of a philanthropic group of entities collectively known as “the Allan & Gill Gray Philanthropy Group”.
The Applicant/Guardian acknowledges that the Foundation requires certain personal information of the Applicant/Guardian as
defined in POPIA and any the relevant data protection legislation (“Personal Information”), to give effect to the rights and
obligations of the Applicant/Guardian as contained herein.

The Applicant/Guardian hereby consents to the Foundation:

• Processing the personal information for the purposes contained in the agreement or any other related purpose.
• Collecting the personal information from the applicant/guardian directly or, where applicable, from any appointed agent,
regulator, government department or third party that may hold such personal information.
• Transferring the personal information to any of the entities forming part of the Allan & Gill Gray Philanthropy Group for the
purposes contained in this agreement or any other related purpose and for the purposes of storing and maintaining the
personal information.
• Transferring the personal information to strategic third parties in furtherance of the purposes contained in this agreement or
any other related purpose and allowing such strategic third parties to contact you, if necessary, in the execution of their
mandate.
• Using the personal information to assess and improve the strategic objectives of the Foundation and the Allan & Gill Gray
Philanthropy Group which includes for operational, internal and external assessment purposes, marketing, audit, legal
and record-keeping purposes.
• Using personal information for research statistical, monitoring and evaluation purposes.
• Storing personal information on our data management system.
• Share your details with other scholarship providers, should you be unsuccessful for the Scholarship opportunity.
• Share the outcome of your application with your school, Department of Education District officials or universities and
partner organisations.
• Share your personal information with any of the other entities forming part of Allan & Gill Gray Philanthropies for the purposes
contained in this consent section and any other related purposes.

Allan Gray Orbis Foundation confirms that it has sufficient security measures in place to ensure the integrity and confidentiality
of the Personal Information received and where transmitted to member entities of Allan & Gill Gray Philanthropies.

While you may, unless legislation requires the processing, object to the processing of your personal information by Allan Gray
Orbis Foundation, such objection may impact the abilities of Allan Gray Orbis Foundation to process and assess your application.
You may at any time access the personal information and may further request rectification of the personal information, should
this be necessary.

By signing this document, the Applicant and Parent/Guardian consents to (a) the use of his/her Personal Information for the
purposes set out herein (b) photographs being taken and video recordings made of the Applicant, and confirms that the Personal
Information is supplied voluntarily, without undue influence from any party and not under any duress.

Applicant Signature Parent/Legal Guardian signature

Date Date

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ANNEXURE B: CONSENT TO PERFORM A CREDIT CHECK

I, Name and Surname: __________________________________________

Identity number: ______________________________________________

Hereby consent that, and authorise The Allan Gray Orbis Foundation and its representative(s) to:-

1. To contact, request and obtain credit information (for the avoidance of doubt this includes any and all information held on
my profile by Experian South Africa (Pty) Ltd (“Experian”) including payment profile information) from Experian (a registered
credit bureau) to verify my identity, perform an assessment of my behaviour, profile, payment patterns, indebtedness,
whereabouts, and creditworthiness or another related purposes in any format (including in pdf, xml or raw data string)
available from Experian and to continuously access my information from Experian for as long as I may have a relationship
with the Company,
2. make any reasonable enquiries to verify and research any details provided by me to the Company;

3. to access the information in any format, including online, batch and raw xml string and I consent that the enquiry should not
be displayed on my credit profile if the enquiry was not performed for credit application purposes;

4. to submit my information, including payment profile and default information and any other relevant information, to Experian
and to allow Experian to release the information for lawful purposes to third parties.

Signed at: _______________________________ on the _________ day of __________________________ 20_____

_______________________
Signed

The information provided in this document does not, and is not intended to, constitute legal advice; instead, this template clause
should only be regarded as a guideline and be used for general informational purposes and we recommend that you seek a legal
opinion on the matter from your legal advisors.

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PARTICIPANT INDEMNITY FORM

PLEASE NOTE THAT:

This form is intended to:

• limit the risk or liability of ALLAN GRAY ORBIS FOUNDATION; and

• constitute an assumption of risk or liability on yourself as a participant.

This form will impose an obligation on yourself to indemnify ALLAN GRAY ORBIS FOUNDATION for any negligence and
you are required to carefully peruse the contents thereof and consult a legal practitioner to fully understand the meaning
thereof.

Full names ____________________________________________ Identity/Passport No ___________________________

Address ___________________________________________________________________________________________

1. I hereby agree not to hold Allan Gray Orbis Foundation, its board members, officers, employees, members, sponsors,
donors or agents liable for any injury, personal harm, death, financial loss or other loss, or damage to intellectual or
material property that I may sustain while participating in the Scholarship Interviews and Exam hosted by Allan Gray Orbis
Foundation, at any date or venue at which the event will take place, including traveling to and from the venue, whether
sustained by conduct, misrepresentation, theft, fire, electricity failures, explosion, severe weather conditions (including
hail, lightning, rain or wind) labour disputes, acts of war and acts of terrorism, whether the loss or damage is due to the
negligence or not of Allan Gray Orbis Foundation, its board members, officers, employees, volunteers, sponsors, donors
or agents.

2. I accept and assume all risks, dangers and hazards and the possibility of personal injury, death, permanent disability,
property damage or loss as a result of my participation in the Scholarship Interviews and Exam.

3. I accept and assume all risks, dangers and hazards associated participating in any of the events, including severe or fatal
injury to others or myself through risks associated with, amongst other, exposure to travel, weather elements and related
activities.

4. I agree not to hold Allan Gray Orbis Foundation, its board members, officers, employees, volunteers, sponsors or agents
liable for any injury, personal harm, death, financial loss or other loss, or damage to intellectual or material property
sustained by third parties as a result of my conduct or omission whilst participating in the Scholarship Interviews and Exam.

5. I understand and agree to the use, reproduction and publication of photographs and video recordings taken by the
Allan Gray Orbis Foundation of myself during my participation in the Scholarship Interviews and Exam for the benefit of
Allan Gray Orbis Foundation.

6. I am fully aware of the potential risk of infection I understand that I am hereby indemnifying Allan Gray Orbis Foundation,
its board members, officers, employees, members, sponsors, donors or agents against potential infection and
transmission of COVID-19 or any other form of infection at the Scholarship Interviews and exam.

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7. I am aware that I am liable for any medical or other expenses that may result from any injury or occurrence.

8. I hereby waive all legal rights that may exist and that I may otherwise have against Allan Gray Orbis Foundation, its board
members, officers, employees, members, sponsors, donors or agents.

9. I understand that if at any time after the return from the event, Allan Gray Orbis Foundation learns that any participant,
employee, director, agent, contractor or officer is infected with a potential infection (for example COVID-19, Cholera),
the Allan Gray Orbis Foundation shall inform me of such fact but shall not be required to disclose the identity of such
person to me.

I confirm that I understand the contents of the above.

Signed on ___________________________ (date) at _________________________________________________ (place)

Signature (Participant) ________________________ Full names _____________________________________________

Signature (Parent/Guardian on behalf of Participant (if under 18 year old) ________________________

Full names _____________________________________________ Identity/Passport No _________________________

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