Kursus Registrasie

APPLICATION FORM FOR REITZ AGRICULTURE ACADEMY SHORT COURSE

PLEASE ENCLOSE THE FOLLOWING WITH YOUR APPLICATION:

1. A certified copy of your identity document

2. Certificated copies of all academic qualifications.

3. A certified copy of your marriage certificate (if applicable)

4. Proof of address. Not older than 3 months.

Name of Short Learning Program applying for: *

Option of your choice: *

ATTENDANCE AT THE EXPERIENTAL WEEK IS ONLY PERMITTED FOR PARTICIPANTS WHO HAVE COMPLETED, OR ARE OFFICIALY WRITTEN IN FOR, A MINIMUM OF THREE MODULES OF THE COURSE.

INITIALS *

SURNAME *

FIRST NAME *

MAIDEN NAME

POPULATION GROUP *

GENDER *

TITLE *

DATE OF BIRTH *

MARITIAL STATUS *

ID/PASSPORT NUMBER *

HOME TEL

CELL NO *

WORK TEL *

E-MAIL ADDRESS *

POSTAL ADDRESS *

PHYSICAL POSTAL CODE *

PHYSICAL ADDRESS *

RELATIVE ADDRESS

RELATIVE NAME AND SURNAME *

RELATIVE POSTAL CODE

RELATIVE RELATIONSHIP *

RELATIVE HOME TEL *

RELATIVE WORK TEL *

DISABILITY *

SPECIFY DISABILITY (if applicable)

PAYMENT

PERSONAL INFORMATION OF PERSON RESPONSIBLE FOR THE PAYMENT

INITIALS *

SURNAME *

FIRST NAME *

MAIDEN NAME

POPULATION GROUP *

GENDER *

TITLE *

DATE OF BIRTH *

MARITIAL STATUS *

ID/PASSPORT NUMBER *

HOME TEL

CELL NO *

WORK TEL *

E-MAIL ADDRESS *

POSTAL ADDRESS *

POSTAL CODE *

PHYSICAL ADDRESS *

PHYSICAL POSTAL CODE *

EMPLOYER *

CONTACT NO OF EMPLOYER *

TRAINING RECORD OF APPLICANT

COMPLETE IN REVERSE ORDER (STARTING WITH THE MOST RECENT) ATTACH A COPY OF THE DOCUMENTS TO YOUR APPLICATION FORM

PERIOD *

NAME OF SCHOOL/ UNIVERSITY / COLLEGE *

GRADE (APPLICABLE TO SCHOOL QUALIFICATION/ NAME OF DEGREE/ DIPLOMA/ CERTIFICATE) *

PERIOD

NAME OF SCHOOL/ UNIVERSITY / COLLEGE

GRADE (APPLICABLE TO SCHOOL QUALIFICATION/ NAME OF DEGREE/ DIPLOMA/ CERTIFICATE)

PERIOD

NAME OF SCHOOL/ UNIVERSITY / COLLEGE

GRADE (APPLICABLE TO SCHOOL QUALIFICATION/ NAME OF DEGREE/ DIPLOMA/ CERTIFICATE)

EMPLOYMENT RECORD OF APPLICANT

COMPLETE IN REVERSE ORDER (STARING WITH THE MOST RECENT)

OCCUPATION *

PERIOD

OCCUPATION

EMPLOYER

PERIOD

OCCUPATION

EMPLOYER

METHOD OF PAYMENT

HTML

Pay directly into bank account.

Banking details:

Account Name: Reitz Landbou Akademie

Bank: Standard Bank

Account number: 301666695

Code & branch: Reitz, 051001

Reference: Name & Surname

Send proof of payment to: info@reitzlandbouakademie.co.za

A certified copy of your identity document *

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Certificated copies of all academic qualifications.

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A certified copy of your marriage certificate (if applicable)

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Proof of address. Not older than 3 months *

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