FAI 24

Faculty ofACCOUNTING & INFORMATICSAddress: Old Hotel School, Ritson Road CampusTel: (031) 373 5152/5826

ADVANCED DIPLOMA AND POSTGRADUATE STUDIES APPLICATION FORM

Student Number Year of Registration

Title Surname

Initials First Names

Date of Birth Day Month Year

Identity Number

Passport Number (For International Students)

Postal Address

Postal Code

Telephone (Home) Cellphone

Telephone (Work) E-Mail

Fax Number

What Programme Are You Applying For (Eg Advanced Dip: Dental Technology, Master's: Dental Technology)

CURRENT / PREVIOUS TERTIARY STUDIES

From To Institution Qualification Name Student Number

Qualification Complete

Awaiting Results

YES NO YES NO

YES NO YES NO

Have you ever been excluded from a tertiary institution or residence? YES NO

If yes, please provide the year of exclusion.

Institution and Details of Exclusion

Marital Status

Routing: Student → Head of Department → Faculty Office

FAS 24

Are you enrolled or do you intend enrolling at another institution while studying at DUT? YES NO

If Yes : Institution and Qualification

Please also complete Form 22 Applicant Biographical Information and attach it to this application together with certified copies of the following documentation (where relevant):

▸ Diploma/Degree and any further qualifications you may have.

▸ ID Document/ Passport

▸ Students that are transferring from other Institutions (except DUT) must provide an original copy of theiracademic record and a certificate of conduct.

▸ Matric/School Leaving Certificate

▸ International applicants must further attach the following:-- Study Permit/Visa- Medical Aid- Matriculation Exemption (where applicable)- SAQA Evaluation (Students with foreign qualifications are required to have their qualifications assessed toconfirm that they are equivalent to a South African qualification. This evaluation is carried out by SAQA (SouthAfrican Qualifications Authority). (See the DUT International Applicants' Information brochure on the DUTwebsite.)

DECLARATION BY APPLICANT

I, (name and surname) the undersigned applicant, declare that all the information supplied is true and that none of the information requested has been withheld. I understand that an incomplete application will not be processed. I further understand that the department applies selection procedures and that offers of places may be withdrawn if conditions are not met or if the University discovers that I have provided false information in my application for admission. (Any persons providing fraudulent documentation shall be subject to a disciplinary hearing.)

Signature of Applicant:.................................................................. Date :...................................

FOR ACADEMIC DEPARTMENT USE ONLY

ACCEPTED INTO PROGRAMME

I confirm that the applicant meets the admission requirements to register for this programme.

Signature of HOD: ................................................................................... Date:………………………………

YES NO

Routing: Student → Head of Department → Faculty Office

Qualification code: ___________ Block code:_______________ Offering type:_____________ Study period:____

If no, reason for non-acceptance:._____________________________________________________________

VALIDITY DATE OF ACCEPTANCE: ______________

FAI 22

Faculty of ACCOUNTING & INFORMATICS Address: Tel:

Old Hotel School, Ritson Road Campus (031) 373 5670/5826

APPLICANT BIOGRAPHICAL INFORMATION

This form is intended to capture all your vital information necessary for our administrative process. Please fill in all information correctly and legibly.

PERSONAL INFORMATION

STUDENT NUMBER REGISTRATION YEAR

1. SURNAME (IN FULL) 2. INITIAL/S

3. FIRST NAMES (IN FULL) 4. TITLE(MR/MRS/MS)

5. MAIDEN NAME(IF MARRIED)

6. DATE OFBIRTH(DD/MM/YYYY)

7. IDENTITY/PASSPORT NO. 8. GENDER

9. MARITAL STATUS(Please tick the correct box)

SINGLE MARRIED DIVORCED WIDOW 14. RACE

13. OCCUPATION(Please tick the correct box)

EMPLOYED BYEXTERNAL EMPLOYER

EMPLOYED BY

DUT

UN- EMPLOYED

12. RELIGION

42. DO YOU HAVE ANYDISABILITIES? if so, pleasedescribe your disability

YES NO 11. HOMELANGUAGE

21. WHAT WAS YOURACTIVITY LAST YEAR?Were you employed or astudent or matric, etc.

22. NAME OF LASTTERTIARY INSTITUITIONREGISTERED AT(If applicable)

CITIZENSHIP 15. ARE YOU A SOUTHAFRICAN CITIZEN?Please tick the correct box

YES NO 10. IF NO,WHATAPPLICANT TYPEYOU?Please tick the correct box.

INTER- NATIONAL

CITIZEN

SADC CITIZEN

ONLY INTERNATIONAL STUDENTS TO ANSWER QUESTIONS 17 TO 20

17. WHAT IS YOUR COUNTRY OFORIGIN?

i.e. The country where you were born.

18. ARE YOUCURRENTLY ASA PERMANENTRESIDENT

YES NO

19. STUDY PERMIT NO. 20.STUDYPERMIT EXPIRYDATE

PREVIOUS QUALIFICATIONS

24. HIGHEST GRADEPASSED IN SECONDARYSCHOOL

25.YEAR & MNTHMATRIC EXAMWAS WRITTEN

26. MATRIC EXAM NO

39. NAME OF PREVIOUSQUALIFICATION(Other than DUT)

40. YEAR OFGRADUATION

41. NAME OF PREVIOUSINSTITUITION

23. EXEMPTIONOF SUBJECTSREQUIRED

YES NO

43. MATRIC SCHOOL NAME

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UndertakingIndemnityForm /updated/ 02.10.2014 Initial here [ ]

NEW STUDENT UNDERTAKING AND INDEMNITY FOR ALL PERIODS OF REGISTRATION

IMPORTANT NOTES TO NEW STUDENT:

YOUR REGISTRATION WILL NOT BE COMPLETED/FINALISED UNTIL BOTH THIS FORM AND THE SEPARATE DEED OF

SURETYSHIP ARE COMPLETED, SIGNED AND SUBMITTED. THE ORIGINAL FORMS MUST BE SUBMITTED TO THE FACULTY

OFFICE AND THE DEED OF SURETYSHIP MUST BE SUBMITTED TO THE FINANCE DEPARTMENT.

IF YOU ARE UNDER 18 YEARS OLD THEN YOUR PARENTS OR LEGAL GUARDIANS MUST COMPLETE AND SIGN THE ASSISTANCE AND UNDERTAKING SECTION AT THE END OF THIS FORM

___________________________________________________________________________________________________________________________________________________________

FULL NAMES OF STUDENT: ……………………………………………………………………………………………………………………………………………………………………..………………..…

STUDENT NO:……………………………………………………………………….…… I D NO: ……………………………………………………………………..................................

I, the abovenamed and undersigned Student, hereby accept and agree to the following:

1. I understand and agree that upon registration I will attend the Durban University of Technology (hereafter referred to as the DUT) and undertake all activities at the DUT entirely at my own risk.

2. I hereby release, indemnify and absolve the DUT, its Council, its staff, its agents, representatives (and all persons for whom it is vicariously liable) from all liability in

respect of any claim which I, my estate, my dependants or any other person may have, arising from loss or damage to property owned by me or in my possession or

under my control or from bodily injury to me or my death regardless of the nature or cause of such loss, damage, injury or death and regardless of whether it be caused

by the negligent act or omission of the DUT, its Council, its staff, its agents, representatives or other persons for whom it is vicariously liable. I understand the nature and

extent of this release. However, in the event that the DUT is held to be liable to me, my estate, my dependants or any other person in respect of any claim arising as

aforesaid, then I agree that such liability shall be limited to the extent to which such claim is covered and met by DUT’s insurance policies

3. I shall at all times abide by and accept all the rules and regulations of the DUT currently in force and as amended from time to time, as published in the:

3.1 “General Handbook for Students”;

3.2 “Fees and Finance Rules” handbook;

3.3 “Department Handbook” relevant to me; and,

3.4 “Student Housing Code of Conduct” handbook.

4. I agree and undertake to make payment of all fees and charges by the due date for payment, and I accept and undertake to abide by the conditions relating to payment of

fees and charges and deregistration. Should I fail to make timeous payment of any fee or charge due by me to the DUT, then I agree that the DUT shall be entitled to

charge me interest on the amount due at the maximum rate of interest applicable to incidental credit agreements from time to time as provided for in the National Credit

Act, 34 of 2005, (currently 2% per month) and published in the “Fees and Finance Rules” handbook.

5. I understand and accept that if any fees or charges due by me to the DUT have not been paid in full and/or any library books and/or any other property on loan from the

DUT and are not returned by due date then, notwithstanding anything to the contrary, the DUT shall be entitled to cancel my registration and / or withhold my examination

results until such time as I pay the outstanding fees or charges and/or return any outstanding library books or property to the DUT.

6. I agree to be liable for all legal costs incurred by the DUT as between attorney and own client, including collection charges, as a result of any instructions given by the

DUT to it’s attorneys for the recovery of any arrear fees or charges or property, irrespective of whether legal action is instituted against me.

7. I understand and accept that non-attendance of the academic programme by me for any reason whatsoever does not absolve me from making full payment of the full

programme fees and does not entitle me to claim any refund of or reduction in the academic programme fees which may already have been paid. I further undertake to

inform the Head of Department concerned, of my withdrawal from the academic programme on the prescribed form.

8. I grant consent to the Durban University of Technology in terms of section 18 of the Protection of Personal Information Act 4 of 2013 to utilise and store my personal

information for the purposes of processing my application for study, residence, bursary or loan applications, verification of results/ qualifications/certificates of good

conduct, credit verification checks, bursars reports, Department of Higher Education reports………………….. ”

9. As a Student of the DUT, I understand that in addition to any Departmental pre-requisites, I am required to obtain a Senior Certificate or equivalent qualification as a

minimum requirement for registration. I undertake to produce to the DUT my original Senior Certificate (or equivalent) Results Statement when I first register so that the

DUT can make certified copies thereof. I agree to any measure taken by the Institution to check and authenticate any documentation submitted for admission.

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UndertakingIndemnityForm /updated/ 02.10.2014 Initial here [ ]

10. If I have previously registered at any other tertiary institution, I undertake to produce to the DUT upon registration a certificate of good conduct and an academic record

from that other institution. I agree to any measure taken by the Institution to check and authenticate any documentation submitted for admission.

11. If I am a student who requires a study visa, I undertake to produce the original of such visa to the DUT when I first register as well as a Certificate of Evaluation from

SAQA (if required by the DUT) so that the DUT can make certified copies thereof.

12. I am aware that my registration may be cancelled by the DUT at any time if my registration fails to comply with any rules or regulations of the DUT in any way.

13. I warrant that all information and particulars furnished on this form and on my New Student Registration form are true and correct and I undertake to notify the DUT in

writing immediately if any of the details or information changes. I hereby acknowledge that a breach of this warranty constitutes a material breach of the agreement which

will entitle the DUT, without prejudice to any other rights or remedies which it may have, to cancel my registration at the DUT. .

14. I understand and accept that this undertaking and indemnity will operate as a continuing undertaking and indemnity and cover all my periods of registration as a student

of the DUT. I further understand and accept that I will still be required to register at the commencement of each relevant academic period.

15. I understand and accept that unless the offer of a place in residence has officially been made to me, and has been accepted by me, and I have been registered as a student

of DUT, the DUT is not obliged to provide me with residence accommodation.

16. I choose the following physical address as the address at which the DUT may serve any notices or legal processes on me (that is, my domicillium citandi et executandi ):

Physical Address : ……………………………………………………………………………………………………………………………………………………………..…………...………….……

………………………………………………………………………………………………………………………………………..………………………Postal Code …………………….……..………..

17. With regard to any information which I may provide on any of the DUT’s official forms, IT databases or financial records, I hereby consent to the DUT sharing such

information with, or disclosing such information to, any member of its staff, its agents, NSFAS, the Department of Higher Education and Training and any other party as

may be necessary for the purposes of debt collection, marketing, qualification accreditation, customer surveys, alumni or any other reasonable business or academic

purposes.

……………………………………….……………….. ……………………………………………….. ………………………………………………………….………

SIGNATURE OF STUDENT DATE PLACE

ASSISTANCE, INDEMNITY AND UNDERTAKING BY THE PARENTS / LEGAL GUARDIANS OF STUDENT UNDER 18 YEARS OLD

Insofar as the Student referred to above is a minor, we the undersigned parents or legal guardians of the Student, sign this document together with the Student in order to

assist the Student and to give him or her the necessary legal and contractual capacity to bind himself or herself to all the terms and conditions set out above.

We consent to the Student signing this document and any other necessary forms relating to the Student’s registration with or residence at DUT.

By our signature hereto we irrevocably undertake that we will not, in any capacity, hold DUT liable for any damage or loss of whatsoever nature which the Student and/or

we and/or any other person may suffer arising out of the Student’s registration with or residence at DUT or any DUT approved out-sourced residence.

We hereby release, indemnify and absolve DUT, its Council, staff, agents, representatives (and all other persons for whom it is vicariously liable) from any liability in

respect of any claim which we or any other person may have arising from any loss or damage to property owned by or in the Student’s possession or control or from any

bodily injury to or death of the Student, regardless of the nature or cause of such loss, damage, injury or death and regardless of whether it be caused by the negligent act

or omission of the DUT, its Council, its staff, its agents, representatives or other persons for whom it is vicariously liable. We understand the nature and extent of this

release. However, in the event that the DUT is held to be liable in respect of any claim arising as aforesaid, then we agree that such liability shall be limited to the extent to

which such claim is covered and met by DUT’s insurance policies.

…………………………………………………………….. ……………………………………………… ……………………………………….……… SIGNATURE OF MOTHER/LEGAL GUARDIAN DATE PLACE

…………………………………………………………….. ……………………………………………… ………………………………..……………… SIGNATURE OF FATHER/LEGAL GUARDIAN DATE PLACE

Names of Parents/Legal Guardians: ………………………………………………………………………………………..………………………………………………………………...

I D Numbers: ……………………………………………………………...…….………………………………………………………………………………………………………………..

Tel No: (Home)………………................(Business).………………………………(Cellular)……………………………………… E-Mail Address : ………………………………...

Physical Residential Address : ……………………………………….………………………………………………………………………………………………………..……………….………………

……………………………………………………………………..…………………………………………………………………………………….Postal Code ……………………..……….………