SECTION K NSFAS Loan Application form - Unisa

SECTION K
NSFAS Loan Application form
Undergraduate/Honours Studies 2011 academic year
Important: Please refer to the student funding information on page 68 before completing this form
For office use only
Student no
File no
Are you an undergraduate applicant?
Yes
No
Are you an honours applicant?
Yes
No
Sem 1: 1 August 2010 to 30 September 2010 Closing date: 28 February 2011
Sem 2: 14 March 2011 to 29 April 2011
FOR OFFICE USE ONLY
Total annual income Number of lawful H/H Number of tertiary students
Remaining term of sentence
Comments
DSF officer’s name
Signature
1 Personal particulars
Identity number
Are you subject to a financial administration order (insolvency) for unpaid debt?
Yes
No
Have you been declared mentally unfit by the court of law to enter into any legal agreement?
Yes
No
Marital status: Single Married If married Widowed Divorced
In community of property
Antenuptial contract
Prison student
Yes
No
If yes, please attach the prisoner’s profile from authorities indicating term of
sentence, years already served and remaining years to be served
2 Academic essential details (refer to the list of bookshops on page 68)
Code: Bookstore: Location:
3 Employment details
Are you employed?
Yes
No
3.1 If yes, please complete section 3.2
If no, please complete sections 3.3 and 4
3.2 Applicant’s employment details (attach certified proof of income)
Name of employer
Address
Tel number
Annual salary (attach proof of income)
my Choice @ Unisa 2011 Loan Application Form

3.3 Employment details of person responsible for your basic needs if you are not
working (attach proof of income)
Surname and initials
Relationship to applicant
Name and address of employer
4 Details of parent or legal guardian
(Please attach certified copies of IDs, death certificates and payslips if employed.
NB: If one or both parents are unknown, please provide details in an affidavit.)
Name & surname Father Mother Guardian
ID number (attach
certified copy of ID)
Residential address
Employer name
Employer address
Tel number
Annual salary
(attach proof of income)
5 Particulars of next of kin: mother, father, sister, brother, cousin, partner, aunt or uncle
Surname Initials Title
Relationship to applicant
Postal address
Telephone number
Cell number
6 Particulars of lawful household (eg parents/guardian, other dependants, starting with applicant)
Please use a separate page if the space provided below is insufficient. Attach certified copies of
RSA identity documents or birth certificates of all members of lawful household.
Name & surname Date of birth Relationship to applicant Student Scholar Employed Unemployed
Send your complete NSFAS application form, together with the requested supporting documents, to Unisa
Student Funding, Registration Building, Hall B, Sunnyside, PO Box 392, Unisa, 003 OR deliver it to any of the
Unisa regional centres (Student Administration Directorate).
NB: Faxed or incomplete applications will not be considered.
7 Declaration
I declare that I have read and understood the contents of this Loan Application Form, and that the information
supplied by me is true and correct. I also understand that should any of the information/documents herewith be
proven to be incorrect or falsified, disciplinary action will be taken against me.
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Student’s signature
Date
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Parent/guardian’s signature (if student is under 18)
Date