NCPBP Application Form 2025

BURSARY APPLICATION FORM
NORTHERN CAPE PROVINCIAL GOVERNMENT

PREMIER’S BURSARY PROGRAMME
INSTRUCTIONS:
1. Read carefully before completing, signing or submitting this form.

2. This form must be completed in full, with black ink and certified copies of the
documents listed in Annexure A should be provided. Certified copies must not be
older than 6 months.
3. This bursary shall not be utilised for pre-existing / current study debt.
4. It is important to note that any misrepresentation of / failure to disclose
information shall result in immediate disqualification of application and or
the bursary, if granted, will be terminated.
5. It is expected of the applicant to disclose the outcomes of any other
bursary / loan/ co-funding applications.
CRITERIA:
a) The application form must be duly signed.

b) The bursary covers undergraduate studies / first qualification only.
c) In order for a student to qualify for a bursary, he /she must be accepted at an
accredited Higher Education Institution.
d) Incomplete application forms or applications with insufficient information,
according to the checklist, shall be disqualified.
e) Application forms must be hand delivered to 31A Angel Street, New Park,
KIMBERLEY or emailed to BursAdmin@ncpetf.onmicrosoft.com
f) Closing date for ALL applications is Friday, 08 November 2024.
g) Late applications will not be considered.
NOTE:
1. It is the responsibility of the student to ensure the following are adhered to:
a. ALL listed items as contained in Annexure A, are attached to the Application
Form.
SECTION A – PERSONAL DETAILS OF THE APPLICANT
Surname
Full names
Date of birth Age
Place of birth
Identity number
SA Citizenship Yes No
Gender Male Female
Race African Coloured Indian White
Do you have a Yes No If Yes, specify & attach medical proof
disability
Physical
address
Page 1 of 4 Bursary Application Form - 2025 Academic Year

Contact numbers Cellular 1: Cellular 2:
Parent / Guardian: Parent / Guardian:
District: Frances JT Pixley Ka Namakwa ZF Mgcawu

Baard Gaetsewe Seme
Marital status
Email address
Alternative email
address
Have you ever No Yes If yes, specify
been found guilty
of a criminal
offence?
Are you No Yes If yes, provide employer’s details
employed?
Occupation
 Attach certified copy of Identity document and related information (See attached
Annexure)
SECTION B – HIGH SCHOOL INFORMATION
Name of
school
School
address
Province
Grade
Years From: To:

attended
Year
completed
Grade 12
• Attach certified proof of latest results

SECTION C - POST MATRIC RESULTS / ENROLLED STUDENT
Qualification Yes No
obtained
If yes, provide
qualification details
Year of completion
Higher Education
Institution
Nature of Diploma Degree Post Graduate
Qualification Qualification
Current Status
(indicate whether
you are an existing
student / or
previous registration
with other higher
education
institutions
Student number
Year of study in
2025
• Attach certified full academic record (See attached Annexure)
SECTION D – INTENDED FIELD OF STUDY FOR 2025 ACADEMIC YEAR
Option1: Institution
Course Details
Option 2: Institution
Course Details
Did you apply for any other Yes No If yes, provide details
funding?
Are you receiving any other Yes No If yes, provide details

form of financial assistance
/ bursary / loan / co-
funding?
 Attach proof of registration & tax invoice / quotation from the institution and related information
(See attached Annexure)

SECTION E – PERSONAL DETAILS OF PARENT / GUARDIAN / NEXT OF KIN / SPOUSE
Parent /Guardian 1 Proof of guardianship must be attached

/Spouse
Surname
Full names
Identity number
Relationship to
student
Physical Address
Employer details
Job title
Annual Income
Telephone numbers Work: Cellular:
with dialling codes
Email address
Parent 2 Proof of guardianship must be attached

Surname
Full names
Identity number
Relationship to
student
Physical address
Employer details
Job title
Annual Income
Telephone numbers Work: Cellular:
with dialling codes
Email address
 Attach certified ID documents; proof of income of both parents / guardians and related
information (see attached Annexure)
SECTION F - DECLARATION BY APPLICANT
I, (full name & surname),………………..…………………….. hereby declare that ALL information provided
in this Application is complete and factual.
I acknowledge that any misrepresentation of information and or failure to disclose information will
lead to my application being rejected.
By submitting this application, I give consent to the Office of the Premier, through the
Premier’s Bursary Programme, to do a background verification and financial check on my
parent(s)/guardian(s) and myself.
Full Name: ………………………....... Signature: ………………………… Date: ……………
Signature of Parent/Guardian if applicant is a minor…………………….. Date: ……………

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BURSARY APPLICATION FORM

NORTHERN CAPE PROVINCIAL GOVERNMENT

1. Read carefully before completing, signing or submitting this form.

a) The application form must be duly signed.

SECTION A – PERSONAL DETAILS OF THE APPLICANT

Page 1 of 4 Bursary Application Form - 2025 Academic Year

District: Frances JT Pixley Ka Namakwa ZF Mgcawu

SECTION B – HIGH SCHOOL INFORMATION

Years From: To:

Page 2 of 4 Bursary Application Form - 2025 Academic Year

SECTION D – INTENDED FIELD OF STUDY FOR 2025 ACADEMIC YEAR

Are you receiving any other Yes No If yes, provide details

Page 3 of 4 Bursary Application Form - 2025 Academic Year

Parent /Guardian 1 Proof of guardianship must be attached

Parent 2 Proof of guardianship must be attached

SECTION F - DECLARATION BY APPLICANT

Full Name: ………………………....... Signature: ………………………… Date: ……………

Signature of Parent/Guardian if applicant is a minor…………………….. Date: ……………

Page 4 of 4 Bursary Application Form - 2025 Academic Year

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