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Promotion of National Unity and Reconciliation Act, 1995 (Act No. 34 of 1995)

Regulations

Regulations relating to Assistance to Victims in respect of Basic Education, 2014

Annexure

Form 3 : Subsequent Application for Assistance

 

FORM 3 : SUBSEQUENT APPLICATION FOR ASSISTANCE

 

[Regulation 11]

 

 

READ THIS FIRST

 

1. A subsequent Application for assistance means that the learner has already received assistance in terms of the Regulations for a previous year and wants to receive further assistance.

 

2. A learner may only receive further assistance if he or she has been registered at a public school or, under certain circumstances, at a special school where he or she wants to study.

 

3. A learner may only receive assistance in terms of the Regulations for a limited period as mentioned in the Regulations.

 

Certified copies of all required documents confirming the information given in this form must be attached to this application form, otherwise the application will not be considered.




A.1 PARTICULARS OF THE LEARNER

Complete this part only if you are applying for assistance on behalf of another person. Indicate here the particulars of the learner who needs assistance.

1. Title:

 

(Mr, Miss)

2. Surname:

 

3. First Names:

 

4. ID number:

 

5. Date of birth:

6. Gender

 

* Male        /   Female

7. Contact details:

* Home address  /  Home address of other person (if applicable):

(State below the address where the learner who needs assistance live and to which mail may be sent. If he or she does not have an address, state the address of another person who can be contacted, e.g. place of worship, school, community leader, etc.)

 

 

 

* Postal address  /  Postal address of other person (if applicable):

 

 

 

Telephone Numbers:

 

Home: (        )

Work: (        )

Cell no:

Email address:

 
8.
(a) Does the learner who needs assistance have a disability?

YES

NO
(b) If yes, give details of the disability:

 

................................................................................................................................................

 

................................................................................................................................................

 

 

 

_________________________________                        __________________

Signature of the person completing the form                                        Date

on behalf of the learner who needs assistance

 

 

A.2 PARTICULARS OF FINANCIAL ASSISTANCE/AID/CONCESSIONS RECEIVED BY THE LEARNER

Complete this part only if the person who needs assistance has received any form of assistance from the State, for example, a bursary or any discount or has been exempted from paying school fees. Indicate here the form of assistance and the amount received.
1. Name of the institution / person who granted / is to grant the aid / assistance:

 

.................................................................................................................................................

 

2. The year for which aid / assistance was received or is to be received: ...........................................

 

3. Nature and amount of the assistance / aid received or is to be received: .......................................

 

.................................................................................................................................................

 

4. Conditions attached to the aid / assistance: ................................................................................

 

.................................................................................................................................................

 

 

 

 

(Attach documents to support the above information.)

 

 

 

B. PARTICULARS OF SCHOOL WHERE LEARNER IS ENROLLED

 

1. The year for which assistance is applied: ....................................................................................

 

2. Name of school at which learner registered: ..............................................................................

 

3. Is the school a public school or special school: ...........................................................................

 

4. Address of public school or special school: .................................................................................

(Indicate the physical address where the public school or special school is situated)

 

5. Telephone number (if known), of public school or special school: .................................................

 

6. Admission Number: ..................................................................................................................

 

7 Grade in current year of study: .................................................................................................




(Attach documents to support the above information.)

 

C. INFORMATION OF PREVIOUS SCHOOL

1.

(a) Learner attended a previous school:

YES

NO

 

(b) If yes, in which City/Province: ..............................................................................................

 

2. Name of previous school at which learner was registered: .........................................................

 

3. Is the previous school a public school or special school:.............................................................

 

 

 

4. Address of previous public school or special school: ..................................................................

 

...............................................................................................................................................

 

5. Telephone number (if known), of previous public school or special school: ...................................

 

6. Grade passed previous year: ....................................................................................................

 

 

 

 

 

(Attach documents to support the above information, including transfer card, if applicable)

 

 

 

D. PARTICULARS OF FURTHER ASSISTANCE NEEDED
l. Assistance in respect of accommodation:

If assistance is needed in respect of accommodation, complete the following:
1. Boarding home Details:

Name of hostel / boarding home: ........................................................................................

 

Address of hostel / boarding home: ......................................................................................

(Indicate the physical address where the hostel / boarding home is situated.)

 

2. Amount charged for boarding fees academic year which has to be paid: ......................................

(Attach proof of the amount payable and that the learner who needs assistance is hiring accommodation.)

3.

(a) Is the public school or special school attended / to be attended by the learner who needs assistance the nearest public school or special school?

YES

NO

 

4. Banking details of the institution / person in whose bank account the money is to be paid:

 

Name of Account holder: ..............................

 

 

(Bank in question must affix its stamp here to confirm the banking details of the supplier / person)

 

 

Name of bank:..............................................

Branch code: ................................................

Account number: ..........................................

 
II. Assistance in respect of purchasing of school uniform:

If assistance is needed in respect of the purchasing of a school uniform, complete the following:

 

1. Banking details of the institution  / person in whose bank account the money is to be paid:

 

Name of Account holder: ..............................

 

 

(Bank in question must affix its stamp here to confirm the banking details of the supplier / person)

 

 

Name of bank:..............................................

Branch code: ................................................

Account number: ..........................................

 
III. Assistance in respect of transport:

If assistance is needed in respect of the purchasing of a school uniform, complete the following:

 

1. Banking details of the institution / person in whose bank account the money is to be paid:

 

Name of Account holder: ..............................

 

 

(Bank in question must affix its stamp here to confirm the banking details of the institution / person)

 

 

Name of bank:..............................................

Branch code: ................................................

Account number: ..........................................

 

 

_________________________________                        __________________

Signature of the person completing the form                                        Date

on behalf of the learner who needs assistance

 


 

[Form 3 inserted by section 15 of Notice No. R. 1193, GG43890, dated 6 November 2020]