Application for Financial Assistance for

undergraduate studies in 2013

Closing Date: 31 October 2012. No late applications will be considered.

This form is for students new to UCT in 2013.
Only a first undergraduate qualification, or a first diploma, or a capping
diploma, will be considered for undergraduate funding.
Only S.A. citizens and permanent residents are eligible for consideration.
This form provides the University with personal information and is accorded the
strictest confidentiality. It is used only to assess your eligibility for UCT assistance
using the National Means Test as stipulated by government and as
the application for the National Student Financial Aid Scheme Loan.
EFC:

PeopleSoft(PS) ID:

FOR OFFICE USE ONLY

Applicant/Student Number:

PLEASE TICK/CIRCLE THE RELEVANT ANSWER WHERE APPLICABLE.

SECTION A

PERSONAL DETAILS OF APPLICANT/STUDENT

First names:

Last Name/ Surname:

Title (e.g. Mr, Miss,

Mrs, Ms):

Marital Status: Never Married/Married/

Separated/Divorced/Widowed

Identity Number:

Provide proof of permanent residency, if applicable.

Please attach 3 certified copies of your South African identity document.

Are you a citizen or permanent

resident of South Africa?

Have you been placed under

Administrative Order by the court?

Yes

No

Yes

No

Street Address:
Province:
Postal Code:
Dialling
Code:

Cellphone:

Telephone Number:

Email:
Do you have a sibling studying at UCT?

SECTION B

Yes

No

If Yes - UCT Student Number

ACADEMIC INFORMATION

Programme for which you are applying (e.g. BCom): First choice:

Second choice:

Previous Tertiary Qualification:

SECTION C1

IF YOU ARE MARRIED, PLEASE COMPLETE THE FOLLOWING

Name of Spouse:

Surname:

Marital Status:
Identity Number (Spouse):
Please provide a certified copy of your spouses ID document and a certified copy of your marriage certificate.

Spouse Employment Details

Occupation:
Name of Employer:

(Full-time / Part time) Gross Earnings: R

Per week/month/year

Tel. Number:

SECTION C2

If you are orphaned, then you must provide death certificates of both parents with a statement stating how you have been
supporting yourself financially.

SECTION C3

If you have been in full-time employment for three or more years prior to coming to UCT, then you must provide a curriculum
vitae together with a statement of your current financial circumstances.
Page 1 of 6

(COMPLETION OF THIS SECTION IS COMPULSORY)

SECTION C4

PROOF OF ALL INCOME

MUST BE ATTACHED

Personal
information of:
Title:

FATHER

STEPFATHER

GUARDIAN

Please tick

Full Names:

Surname:

Marital Status:

Cellphone:

Identity Number: (Attach certified copy of ID)

Permanent Home Address:

Dialling Code:

Postal Code:

Occupation:

Telephone Number:

Province:

(Full-time / Part time) Gross Earnings: R

Per week/month/year

Employer's Name:

Employer's Tel. Number:

Self employed (Yes / No):

Nature of Business:

Other Income: Maintenance: R

State Allowance: R

Pension: R

Income received from deceased spouse's estate: R

Investment Interest: R

Rental Received: R

Contribution from others: R

1. If widowed, provide certified copy of death certificate of deceased spouse.

2. If divorced, provide certified copy of full divorce agreement.

SECTION C5
Personal
information of:

PROOF OF ALL INCOME

MUST BE ATTACHED

MOTHER

Title:

Full Names:

Marital Status:

Identity Number:

STEPMOTHER

GUARDIAN

Please tick

Surname:

Cellphone:

(Attach certified copy of ID)

Permanent Home Address:

Dialling Code:

Telephone Number:

Postal Code:
Occupation:

(Full-time / Part time)

Gross Earnings: R

Per week/month/year

Employer's Name:

Employer's Tel. Number:

Self employed (Yes / No):

Nature of Business:

Other Income: Maintenance: R

State Allowance: R

Income received from deceased spouse's estate: R

Rental Received: R

Pension: R
Investment Interest: R

Contribution from others: R

1. If widowed, provide certified copy of death certificate of deceased spouse.

2. If divorced, provide certified copy of full divorce agreement.

Page 2 of 6

FAMILY MONTHLY INCOME AND EXPENDITURE STATEMENT

(To be completed by the parents and/or the the guardian and/or student spouse.)

EXPENDITURE

RAND VALUE

INCOME
1)

Salaries

Rent

2)

Business

Bond

3)

Informal Selling (hawking)

Loans

4)

Pensions

Rates

5)

Disability Grants

Groceries

6)

Foster Grant

Maintenance

7)

Child Grant

Telephone

8)

Rental Income

Clothing

9)

Estate/Trust Fund Income

Transport

10) Investment Income

SECTION D

RAND VALUE

Motor vehicle/s

(COMPLETION OF THIS SECTION IS COMPULSORY)

DETAILS OF ALL PERSONS DEPENDENT ON THE FAMILY INCOME

PROOF OF ALL INCOME

MUST BE ATTACHED

Certified copies of birth certificates or ID documents of all household members to be attached.

Please list ALL those who are dependent on the family's total monthly income.
If you have a sibling studying at another tertiary institution please provide proof of their registration and indicate their year of study.
Name

Age

How is this person

related to you
(e.g. mother,
wife, son)

OFFICE USE ONLY

Page 3 of 6

If the person is
not part of your
immediate family,
state why the
person is a
dependant.

Please state which

of the following
categories the
person falls into:
pre-schoolchild;
scholar; student at
a College, University
of Technology
or University; adult.

Indicate the type

of income received
by the dependents.
Wages/Salary/
Pension/ Child
Support/ Interest
on Investment/
Business Profit

SECTION E

DETAILS OF ASSETS

Details of property(s) owned by applicant/spouse/mother/father/legal guardian

Description and Address

Market Value
(provide proof)

Monthly Bond Repayment

(provide proof)

Bond Balance

1)
2)
3)

PROVIDE PROOF OF LEASE AGREEMENT IF RENTING YOUR HOME

DETAILS OF MOTOR VEHICLE(S) OWNED BY APPLICANT/SPOUSE/MOTHER/FATHER/LEGAL GUARDIAN
Description of Motor Vehicle(s)

Year

Market Value

Balance owing

1)
2)
3)

SECTION F

UCT WILL NOT HESITATE TO TAKE LEGAL ACTION IF SIGNATURES OR INFORMATION HAVE BEEN WILFULLY
FORGED OR FALSELY GIVEN. INCOMPLETE AND UNSIGNED FORMS WILL NOT BE CONSIDERED.

Declaration by biological parent/spouse/court-appointed legal guardian

(To be completed by parent /spouse or legal guardian even if student is over 21 years of age.)

and I

declare that the information stated in Section C

(mother/guardian/spouse)

(father)

is true to the best of my knowledge and belief. I have submitted this information knowing that, if tendered in evidence, I would be liable for prosecution if I wilfully state in
it anything which I know to be false or which I do not believe to be true. In the interest of good governance and accountability for Public Funds, I agree that the University
may request my individual profile from the Transunion Credit Bureau to verify my employment details.
Date:
(Signature Mother/Guardian/Spouse)

(Signature Father)

As witnessed by
(Signature of witness)

(Initials and last name of witness)

DECLARATION BY APPLICANT/STUDENT:

I
hereby declare
that the information stated in this application, including the information about my parents/spouse/legal guardian in Section C, is true to the best of my knowledge and belief.
I have submitted this information knowing that, if I wilfully stated in it anything which I know to be false or which I do not believe to be true, I may be declared ineligible for
all financial assistance, and any financial assistance already granted may be withdrawn and any sums paid to me or on my behalf may be recovered from me and disciplinary
action may be taken against me, either in the university courts or in the civil courts. I further undertake to inform the Student Financial Aid Office of any change in my
circumstances. I acknowledge that should I fail to do so and continue to receive financial assistance which I would not be entitled to by reason of my changed circumstances,
the University may have recourse against me in any of the ways set out above.
Date:

(Signature of applicant/student)

PLEASE TICK THE CHECKLIST TO ENSURE THAT YOU HAVE ATTACHED ALL THE NECESSARY DOCUMENTS
Certified copied of birth certificates or ID's of all members of the family
IF PARENTS ARE EMPLOYED by a company:
Attach salary/wage slips of both parents
IF PARENTS/ GUARDIAN/ SPOUSE ARE A SOLE PROPRIETOR:
The following documents must be provided:

IF PARENTS/ GUARDIAN/ SPOUSE OWN OR BELONG TO A

CC AND/OR A PTY(LTD):
The following documents are required:
Complete Financial statements signed by members and person(s)
drawing up the statements which should include,
An Income Statement,Balance Sheet,Cash Flow statement,
Notes, IT14 - Tax return for the business (last 2 years)

Income statements and balance sheet and IT12 (last 2 years)

IT12 - Tax return for the individual (last 2 years)

IT3 (b) Income Tax Certificate from the Bank, Statement of

Personal Assets and Liabilities (last 2 years)

IT3(b) Income Tax Certificate from the Bank (last 2 years)

Personal Bond statement

Statement of Personal Assets and Liabilities (last 2 years)

Council rates account or a copy of the Lease agreement if renting

Personal Bond statement.

IF PARENTS/ GUARDIAN/ SPOUSE ARE AN INFORMAL TRADER/HAWKER:

The following documents are required:
Proof of Income

IF PARENTS/ GUARDIAN/ SPOUSE ARE UNEMPLOYED

The following documents must be provided:
Official letter from the Department of Labour
proving unemployed status

Bond statement and Council rates account OR

Bond statement and Council rates account OR a

copy of the Lease agreement if renting accommodation.

a copy of the Lease agreement if renting accommodation.

Proof of how the family is being supported financially.

IF PARENTS ARE EARNING COMMISSION:

The following documents must be provided:

If parent/guardian receives income such as pension/

grant/maintenance/rental/interest from investment,
please submit proof thereof.

IRP5, IT3 and IT12

Page 4 of 6

FOR OFFICE USE

Biographical Profile

APPLICANT NUMBER

(Information needed to establish if your profile matches the

profile for named awards)
BATCH

First Name:

SECTION G

CAPTURER

Last Name/Surname:

ACHIEVEMENTS/PARTICIPATION IN THE FOLLOWING AT BOTH SCHOOL AND

POST-SCHOOL LEVEL. PLEASE GIVE AS MUCH INFORMATION AS POSSIBLE:

ACADEMIC
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LEADERSHIP
ROLES
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COMMUNITY
SERVICE
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CULTURAL
ACTIVITIES
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SPORTS/HOBBIES
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SECTION H

FAMILY AND PERSONAL INFORMATION:

WHAT KIND OF WORK DOES YOUR MOTHER AND FATHER DO?

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HOW MANY BROTHERS AND SISTERS DO YOU HAVE WHO ARE NOT AT SCHOOL OR AT A TERTIARY
INSTITUTION BUT ARE DEPENDENT ON THE FAMILY INCOME? WHAT ARE THEY DOING?
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Page 5 of 6

SECTION H CONTINUED ON PAGE 6

IF THEY ARE NOT EMPLOYED, TELL US WHO IS SUPPORTING THE FAMILY?

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PLEASE TELL US IN WHAT AREA YOUR PARENTAL HOME IS; IS IT A RESIDENTIAL SUBURB OR IS IT A
RURAL AREA?
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PLEASE TELL US WHY YOU CHOSE THIS FIELD/ THESE FIELDS OF STUDY.
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IS THERE ANYTHING SPECIAL YOU WOULD LIKE TO TELL US ABOUT YOURSELF?

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SECTION I
Your descent?

SOME BURSARIES HAVE CONDITIONS SET BY BEQUEST OR BY DONORS.

IF APPLICABLE, TICK THE RELEVANT ANSWERS
Old Dutch

Is/was your father/grandfather a freemason?

Huguenot

German

Namibian

British

Yes

No

If yes, which Lodge?

Did your parents/grandparents serve in World War 2? Yes

No

If yes, please attach supporting documents

Have your parents owned property in the Cape Town Municipal area for more than 10 years?

Yes

No

Are you a dependant of an employee/deceased employee/pensioner of Transnet, Cape Western Region?

Yes

No

If yes, please furnish membership number:

Music students: 1st 2nd 3rd instrument: 1

Main teaching subjects:1

(for those intending to teach)

Page 6 of 6