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_____________________________________________________________________________________
Under - Graduate
Post - Graduate
R 200 (TWO HUNDRED RAND) NON REFUNDABLE APPLICATION FEE MUST BE PAID AND THE
DEPOSIT SLIP ATTACHED TO THE APPLICATION FORM UPON SUBMISSION
BANKING DETAILS
Bank :
Standard Bank
Account Holder :
Branch :
Thibault Square
Branch Number :
1.
2.
Academic Year
2017
ACADEMIC DETAILS
A.
1st
Choice
2nd
Choice
Mode of
Study
Sefako Makgatho
Health Sciences
University
020909
Full
Time
B.
For office
use
3.
Title
4.
Initials
5.
6.
Maiden
Name
8.
Identity
Number (RSA)
9.
10.
Passport
Number
(International
Students)
11. Passport
Expiry
Date
7.
Surname
Full
Names
Date of
Birth
Marital Status
14.
Gender
Home Language /
Mother Tongue
15.
16.
Occupation
17.
18.
Residential or
Physical Address
(not school address)
Religion /
Church
Affiliation
Physical
Impairment
(e.g. blind)
19.
20.
Code
Telephone No.
Fax No.
Cell No.
21.
Citizenship /
Nationality
23.
Province /
State
Male
Code
Postal
Address
C.
Female
Ethnic
Group / Race
24.
Rural /
Urban / PeriUrban
Examination
Date
27.
Examination
No.
Senior Certificate
Type
School Name
28.
29.
30.
31.
32.
MATRICULATION DETAILS
26. Highest Grade
(standard if
Applicable)
Examination Department
(e.g. Gauteng, etc.)
Last
December
June
Examination Grade 11
Grade 12
Subjects and
Subject
results of
last
examination
December
Grade 12
Code
Symbol/Level
34.
35.
YES
36.
NO
For office use
For office use
F.
If YES,
When (year)?
No
NO
Period
YES
NO
YES
NO
G.
37.
H.
NO
38.
Title
39.
Residential Address
(not postal address)
40.
YES
Initials
Surname
Relationship
Code
Postal address
Code
41.
42.
43.
44.
Cell phone
YES
NO
Staff
No.
I.
All the information provided in this document is true and that I will abide with
all the rules and regulations of Sefako Makgatho Health Sciences University;
I have concluded this agreement with the knowledge and consent of my
parents/guardian/spouse or next of kin;
I undertake to notify the Registrar in writing, if I wish to cancel my registration
during the current academic semester/year and I acknowledge that I am liable
for fees payable for the respective semester/year.
Certificate of Conduct
SAQA Evaluation
Identity Document / Passport
School Results
Marriage Certificate
Signature : ____________________________
Office Stamp