Fillable FORM 1: [Regulation 10] APPLICATION FOR ASSISTANCE IN (South Africa Department of Justice and Constitutional Development)

Fill Online, Printable, Fillable, Blank FORM 1: [Regulation 10] APPLICATION FOR ASSISTANCE IN (South Africa Department of Justice and Constitutional Development) Form

Use Fill to complete blank online SOUTH AFRICA DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FORM 1: [Regulation 10] APPLICATION FOR ASSISTANCE IN (South Africa Department of Justice and Constitutional Development)

On average this form takes 48 minutes to complete

The FORM 1: [Regulation 10] APPLICATION FOR ASSISTANCE IN (South Africa Department of Justice and Constitutional Development) form is 17 pages long and contains:

  • 0 signatures
  • 60 check-boxes
  • 164 other fields

Country of origin: SOUTH-AFRICA
File type: PDF

Use our library of forms to quickly fill and sign your South Africa Department of Justice and Constitutional Development forms online.

BROWSE SOUTH AFRICA DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
J 942
Department of Justice and Constitutional Development Page 1
REPUBLIC OF SOUTH AFRICA
FORM 1
[Regulation 10]
APPLICATION FOR ASSISTANCE IN RESPECT OF BASIC EDUCATION
PROMOTION OF NATIONAL UNITY AND RECONCILIATION ACT, 1995 (ACT 34 OF 1995)
READ THIS FIRST
Only a person who –
(a) has been found by the Truth and Reconciliation Commission (TRC) to be a victim; or
(b) is a relative, such as the child, or a dependant of a victim, such as a grandchild, may request assistance.
To qualify for assistance-
CLOSING DATE FOR SUBMISSIONS: 30 NOVEMBER
EACH YEAR FOR THE NEXT ACADEMIC YEAR
A. PARTICULARS OF PERSON WHO COMPLETES FORM
1. Title:
(Mr, Miss, Mrs, Dr)
2. Surname:
3. First Names:
4. ID number:
5. Date of birth:
6. Gender:
*Male / Female
7. Contact details:
* Home address / Home address of other person (if applicable):
(State below the address where you live and to which mail may be sent. If you do not have an address, state the
address of another person who can be contacted, e.g. place of worship, school, community leader, etc..)
* Postal address / Postal address of other person (if applicable):
Telephone Numbers:
Home: ( ) Work: ( ) Cell no:
Remember to attach the required documents confirming the information given in this form, for example, certified copies of an
identity book and proof of income, otherwise your application will not be considered.
A vulnerable household is a household consisting of four or more members, where:
*
*
*
*
*
the majority of members are over the age of 65 years;
the majority of members are receiving social assistance;
one member is physically or mentally disabled;
one of the members is under the age of 18 years and has to work; or
only one of the members is working;
A household consists of the spouse, children, grandchildren, parents and grandparents of a victim.
(a) the household of which the person who needs assistance is a member, must not earn more than R209 468,00 gross income
per year; or
(b) the person who needs assistance must be a member of a vulnerable household.
(c) the person who needs assistance must be enrolled in a public school.
J 942
Department of Justice and Constitutional Development Page 2
8. (a) Are you completing this form on behalf of somebody else?
*Yes / No
(b) If you are completing this form on behalf of somebody else, also complete part B (B1 & B2) below.
9. If you are applying for assistance, complete the following:
(a) Are you a victim?
*Yes / No
(b) If you are not a victim -
(i) what is the name of the victim? ………………………………………………………………
(ii) are you a relative or dependant of a victim?
*Yes /No
(c) If you are a relative or dependant of a victim, what is your relationship with the victim: ...……………………………
(for eg: are you the spouse, child, grandchild or sibling of a victim)
10. (a) If you are applying for assistance, do you have any disability?:
*Yes / No
(b) If yes, give details of the disability:
…………………………………………......................…………………………………………………………………………
…………………………………………......................…………………………………………………………………………
________________________ ____________________
Signature Date
B.1 PARTICULARS OF PERSON WHO NEEDS ASSISTANCE
Complete this part only if you are applying for assistance on behalf of another person. Indicate here the particulars of the person
who needs assistance.
1. Title:
(Mr, Miss, Mrs)
2. Surname:
3. First Names:
4. ID number:
5. Date of birth:
6. Gender:
*Male / Female
7. Contact details:
* Home address / Home address of other person (if applicable):
(State below the address where the person who needs assistance live and to which mail may be sent. If he or she
does not have an address, state the address of another person who can be contacted, e.g. place of worship, school,
community leader, etc..)
* Postal address / Postal address of other person (if applicable):
Telephone Numbers:
Home: ( ) Work: ( ) Cell no:
8. Is the person who needs assistance:
(a) A victim?
*Yes / No
(b) If he or she is not a victim -
(i) what is the name of the victim? ………………………………………………………………
(ii) is he or she a relative or dependant of a victim?
*Yes / No
J 942
Department of Justice and Constitutional Development Page 3
(c) If he or she is a relative or dependant of a victim, what is his or her relationship with the victim:
…...……………………………........................................................................................................................................
(for eg: are you the spouse, child, grandchild or sibling of a victim)
9. (a) Does the person who needs assistance have any disability?
*Yes / No
(b) If yes, give details of the disability:
…………………………………………......................…………………………………………………………………………
…………………………………………......................…………………………………………………………………………
___________________________________ ____________________
Signature of the person completing the form Date
on behalf of the person who needs assistance
B.2 PARTICULARS OF FINANCIAL ASSISTANCE/AID/CONCESSIONS RECEIVED BY PERSON WHO NEEDS
ASSISTANCE
Complete this part only if the person who needs assistance has received any form of assistance from the State, for example, a bursary
or any discount or has been exempted from paying school fees. Indicate here the form of assistance and the amount received.
1. Name of the institution / person who granted / is to grant the aid / assistance:
.....………………………………………….…………………………………………………………………………………………
2. The year for which aid / assistance was received or is to be received: ........................
3. Nature and amount of the assistance / aid received or is to be received: ……………………………………………….….…
.....………………………………………….…………………………………………………………………………………………
4. Conditions attached to the aid / assistance: ..................................................................................................................
.....………………………………………….…………………………………………………………………………………………
(Attach documents to support the above information.)
C. FORMS OF ASSISTANCE APPLIED FOR
The forms of assistance include payment of school fees, allowances for the purchasing of school uniforms and
boarding and transport allowances.
C.1 ASSISTANCE IN RESPECT OF GRADE R (Reg 5)
I. Assistance in respect of school fees:
If assistance is needed in respect of school fees, complete the following:
1. Year in respect of which assistance is needed: ……….........
2. Details of School
(a) Name of School: …………….............................................................................................................................
(b) Address of School: ……………..........................................................................................................................
………………………………………..……………………...........................................…………………………………...
(Indicate the physical address, in other words, where the school is situated)
3. Total amount of fees payable to school: ................................................................................................
(Attach proof of enrolment at school and of the amount payable to the school. Indicate
J 942
Department of Justice and Constitutional Development Page 4
whether the amount payable is per annum or term.)
4. Banking details of the school in whose bank account
the money is to be paid :
Name of Account holder:
...............................................................................................
Name of bank: ………………............……………….…………
Branch code: ……….......................................................…...
Account number: ..………………..…………………………...
II. Assistance in respect of accommodation:
If assistance is needed in respect of accommodation, complete the following:
1. Boarding home Details :
Name of hostel / boarding home: …........……………………………………………..........…………..........................
Address of hostel / boarding home: …......…………………………………………………….........…..........................
.........…………….......................................................................................................................................................
(Indicate the physical address, in other words, where the hostel / boarding home is situated.)
2. Amount of boarding fees per annum which has to be paid: ...........................................
(Attach proof of the amount payable and that the person who needs assistance is hiring accommodation.)
3. (a) Is the school attended/to be attended by the person who needs assistance the nearest school?
* Yes /No
(b) If not –
(i) What is the distance between the place of residence of the person who needs assistance and the nearest
school? ................
(ii) Is there public transport available directly from the place of residence of the person who needs assistances
and the nearest school? * Yes /No
(iii) If the person who needs assistance cannot be accommodated at the nearest school, indicate why not:
The nearest school is full
or
The person who needs assistance has special needs, namely
.................................................................................................................................................................
4. Banking details of the institution / person in whose bank account the money is to be paid:
Name of Account holder:
...............................................................................................
Name of bank: ………………............……………….…………
Branch code: ……….......................................................…...
Account number: …………………..…………………………...
III. Assistance in respect of the purchasing of school uniform:
If assistance is needed in respect of the purchasing of a school uniform, complete the following:
1. Does the school attended/to be attended by the person who needs assistance require the wearing of a school
uniform? * Yes /No
(Bank in question must affix its stamp here
to confirm the banking details of the school)
(Bank in question must affix its stamp here
to confirm the banking details of the
hostel/boarding home)
J 942
Department of Justice and Constitutional Development Page 5
2. If yes, amount applied for the school uniform per annum: .......................................
(Attach proof of the amount payable and that the person who needs assistance, is required
to wear a school uniform.)
3. Banking details of the institution / person in whose bank account the money is to be paid:
Name of Account holder:
...............................................................................................
Name of bank: ………………............……………….…………
Branch code: ……….......................................................…...
Account number: …………..………..…………………………...
IV. Assistance in respect of transport:
If assistance is needed in respect of transport, complete the following:
1. Method of transport to be used by the person who needs assistance: ……………………………..........................
2. Particulars of institution / person providing transport: ………………………………………………………………
3. Distance between place of residence of the person who needs assistance and school where education is
offered: .....................................................
4. Amount which has to be paid for transport for the year: ……….........……….
(Attach proof of the amount and of the fact that the person who needs assistance, makes use of this method of transport.)
5. Does the person who needs assistance reside in a school hostel? * Yes /No
6. (a) Is the school attended / to be attended the nearest school? * Yes /No
(b) If not, why not:
The nearest school is full
or
The person who needs assistance has special needs, namely
................................................................................................................................................................
7. Banking details of the institution / person in whose bank account the money is to be paid:
Name of Account holder:
...........................................................................................
Name of bank: ……………............…………………………
Branch code: ………...................................................…...
Account number: …………………..………………………...
______________________________________________ ______________________
Signature of applicant or the person completing the form Date
on behalf of the person who needs assistance
C.2 ASSISTANCE IN RESPECT OF GENERAL EDUCATION (Reg 6)
I. Assistance in respect of school fees:
If assistance is needed in respect of school fees, complete the following:
1. Year in respect of which assistance is needed: ……….........
2. Details of School:
Name of School: ………………….............................................................................................................................
Address of School: …………………..........................................................................................................................
………………………………………………………………...........................................…………………………………...
(Indicate the physical address, in other words, where the school is situated.)
(Bank in question must affix its stamp here
to confirm the banking details of the
institution/person)
(Bank in question must affix its stamp here
to confirm the banking details of the
institution/person)
J 942
Department of Justice and Constitutional Development Page 6
3. Total amount of fees payable to school: ................................................................................................
(Attach proof of enrolment at school and of the amount payable to the school. Indicate whether the amount
payable is per annum or term.)
4. Banking details of the school in whose bank account the money is to be paid :
Name of Account holder:
...........................................................................................
Name of bank: ………………............…………….…………
Branch code: ………....................................................…...
Account number: …………………..……………….………...
II. Assistance in respect of accommodation:
If assistance is needed in respect of accommodation, complete the following:
1. Boarding home Details :
Name of hostel / boarding home: .................…………………………………………………………..........................
Address of hostel / boarding home: .................................................................................................................
………………………………………………………………...........................................…………………………………...
(Indicate the physical address, in other words, where the hostel / boarding home is situated.)
2. Amount of boarding fees per annum which has to be paid: .........................................................
(Attach proof of the amount payable and that the person who needs assistance, is hiring accommodation.)
3. (a) Is the school attended/to be attended by the person who needs assistance the nearest school?
* Yes /No
(b) If not –
(i) What is the distance between the place of residence of the person who needs assistance and the nearest
school? ................
(ii) Is there public transport available directly from the place of residence of the person who needs assistance
and the nearest school? * Yes /No
(iii) If the person who needs assistance cannot be accommodated at the nearest school, indicate why not:
The nearest school is full
Or
The person who needs assistance has special needs, namely
................................................................................................................................................................
4. Banking details of the institution / person in whose bank account the money is to be paid:
Name of Account holder:
..............................................................................................
Name of bank: ………………............…………………………
Branch code: ………......................................................…...
Account number: …………………..………..………………...
III. Assistance in respect of purchasing of school uniform:
If assistance is needed in respect of the purchasing of a school uniform, complete the following:
1. Does the school attended/to be attended by the person who needs assistance require the wearing of a school
uniform ? * Yes /No
(Bank in question must affix its stamp here
to confirm the banking details of the
school)
(Bank in question must affix its stamp here
to confirm the banking details of the
hostel/boarding home)
J 942
Department of Justice and Constitutional Development Page 7
2. If yes, amount applied for the school uniform per annum: ............................................
(Attach proof of the amount payable and that the person who needs assistance, is required
to wear a school uniform)
3. Banking details of the institution / person in whose bank account the money is to be paid:
Name of Account holder:
..............................................................................................
Name of bank: ………………............…………………………
Branch code: ………......................................................…...
Account number: …………………..…………………………...
IV. Assistance in respect of transport:
If assistance is needed in respect of transport, complete the following:
1. Method of transport to be used by the person who needs assistance: …………………………….......................
2. Particulars of institution / person providing transport: ………………………………………………………………
3. Distance between place of residence of the person who needs assistance and school where education is
offered: ...................................................
4. Amount which has to be paid for transport for the year: ……………….
(Attach proof of the amount and of the fact that the person who needs assistance, makes use of this method of transport.)
5. Does the person who needs assistance reside in a school hostel? * Yes /No
6. (a) Is the school attended / to be attended the nearest school? * Yes /No
(b) If not, why not:
The nearest school is full
Or
The person who needs assistance has special needs, namely
..........................................................................................................................................................
7. Banking details of the institution / person in whose bank account the money is to be paid:
Name of Account holder:
...............................................................................................
Name of bank: ………………............…………………………
Branch code: ………......................................................…...
Account number: …………………..…………………………...
_____________________________________________ ______________________
Signature of applicant or the person completing the form Date
on behalf of the person who needs assistance
C.3 ASSISTANCE IN RESPECT OF FURTHER EDUCATION (Reg 7)
I. Assistance in respect of school fees:
If assistance is needed in respect of school fees, complete the following:
1. Year in respect of which assistance is needed: ……….........
2. Details of School
(a) Name of School: …………….............................................................................................................................
(b) Address of School: ……………..........................................................................................................................
(Bank in question must affix its stamp here
to confirm the banking details of the
institution/person)
(Bank in question must affix its stamp here
to confirm the banking details of the
institution/person)
J 942
Department of Justice and Constitutional Development Page 8
………………………………………..……………………...........................................…………………………………...
(Indicate the physical address, in other words, where the school is situated.)
3. Total amount of fees payable to school: ...........................................................
(Attach proof of enrolment at school and of the amount payable to the school. Indicate whether the amount
payable is per annum or term.)
4. Banking details of the school in whose bank account the money is to be paid :
Name of Account holder:
.............................................................................................
Name of bank: ………………............…………………………
Branch code: ………......................................................…...
Account number:…………………..…………………………..
II. Assistance in respect of accommodation:
If assistance is needed in respect of accommodation, complete the following:
1. Boarding home Details :
Name of hostel / boarding home: .................…………………………………………………………..........................
Address of hostel / boarding home: .................................................................................................................
………………………………………………………………...........................................…………………………………...
(Indicate the physical address, in other words, where the hostel / boarding home is situated.)
2. Amount of boarding fees per annum which has to be paid: .........................................................
(Attach proof of the amount payable and that the person who needs assistance, is hiring accommodation.)
3. (a) Is the school attended/to be attended by the person who needs assistance the nearest school?
* Yes /No
(b) If not –
(i) What is the distance between the place of residence of the person who needs assistance and the nearest
school? ................
(ii) Is there public transport available directly from the place of residence of the person who needs assistance
and the nearest school? * Yes /No
(iii) If the person who needs assistance cannot be accommodated at the nearest school, indicate why not:
The nearest school is full
or
Beneficiary has special needs, namely
..............................................................................................................................................................
4. Banking details of the institution / person in whose bank account the money is to be paid:
Name of Account holder:
..............................................................................................
Name of bank: ………………............…………………………
Branch code: ………......................................................…...
Account number: …………………..…………………………..
(Bank in question must affix its stamp here
to confirm the banking details of the
hostel/boarding home)
(Bank in question must affix its stamp here
to confirm the banking details of the
school)
J 942
Department of Justice and Constitutional Development Page 9
III. Assistance for the purchasing of school uniform:
If assistance is applied for in respect of the purchasing of a school uniform, please complete the following:
1. Does the school attended/to be attended by the person who needs assistance require the wearing of a school
uniform ? * Yes /No
2. If yes, amount applied for the school uniform per annum: ......................................................
(Attach proof of the amount payable and that the person who needs assistance, is required to wear a school uniform.)
3. Banking details of the institution / person in whose bank account the money is to be paid:
Name of Account holder:
..............................................................................................
Name of bank: ………………............…………………………
Branch code: ………......................................................…...
Account number: …………………..…………………………..
IV. Assistance in respect of transport:
If assistance is needed in respect of transport, complete the following:
1. Method of transport to be used by the person who needs assistance:
……………………………................................................................................
2. Particulars of Institution / person providing transport: ………………………………………………………………
3. Distance between place of residence of the person who needs assistance and and school where education is
offered: ...................................................
4. Amount which has to be paid for transport for the year: ……………….
(Attach proof of the amount and of the fact that the person who needs assistance, makes use of this method of transport.)
5. Does the person who needs assistance reside in a school hostel? * Yes /No
6. (a) Is the school attended / to be attended the nearest school? * Yes /No
(b) If not, why not:
The nearest school is full
or
The person who needs assistance has special needs, namely
..............................................................................................................................................................
7. Banking details of the institution / person in whose bank account the money is to be paid:
Name of Account holder:
..............................................................................................
Name of bank: ………………............……………….....………
Branch code: ………......................................................…...
Account number:…………………..…………………...………..
____________________________________________ ______________________
Signature of applicant or the person completing the form Date
on behalf of the person who needs assistance
(Bank in question must affix its stamp here
to confirm the banking details of the
institution/person)
(Bank in question must affix its stamp here
to confirm the banking details of the
institution/person)
J 942
Department of Justice and Constitutional Development Page 10
D. PARTICULARS OF COMPOSITION OF HOUSEHOLD
A household consists of the spouse, children, grandchildren, parents and grandparents of a victim.
1. Number of members in household: ..................
2. Number of members in household who are working: ...................
3. Number of members in household who are over the age of 65 years: ....................
4. Number of members in household who are receiving social assistance in terms of ....................
the Social Assistance Act:
5. Number of members in household who are physically or mentally disabled as ....................
contemplated in section 9 of the Social Assistance Act:
6. Number of members in household who are working in order to contribute to the ....................
income of the household and are under the age of 18 years:
(Attach proof in support of the information provided above.)
E. PARTICULARS OF INCOME OF MEMBERS OF HOUSEHOLD
Note that it is not necessary to complete this part if assistance in terms of these Regulations has previously been provided to the
person who needs assistance.
If the space provided on this page is not enough,complete particulars on a separate page/s and attach additional page/s to this form.
Particulars of income of member(s) of household:
(Indicate whether it is a pension, salary, commission or seasonal and if it is seasonal, give details thereof.
Member 1:
Full names and Surname:
……………………….............……………………………................................
ID no.
……………………….............……………………………................................
Gross annual income:
……………………….............……………………………................................
Nature of the income:
……………………….............……………………………................................
Relationship with victim:
……………………….............……………………………................................
Member 2:
Full names and Surname:
……………………….............……………………………................................
ID no.
……………………….............……………………………................................
Gross annual income:
……………………….............……………………………................................
Nature of the income:
……………………….............……………………………................................
Relationship with victim:
……………………….............……………………………................................
Member 3:
Full names and Surname:
……………………….............……………………………................................
ID no.
……………………….............……………………………................................
Gross annual income:
……………………….............……………………………................................
Nature of the income:
……………………….............……………………………................................
Relationship with victim:
……………………….............……………………………................................
J 942
Department of Justice and Constitutional Development Page 11
Member 4:
Full names and Surname:
……………………….............……………………………................................
ID no.
……………………….............……………………………................................
Gross annual income:
……………………….............……………………………................................
Nature of the income:
……………………….............……………………………................................
Relationship with victim:
……………………….............……………………………................................
F. CERTIFICATION
I, ………………………………………………………………………………………………………………., hereby certify that the
information which I have provided above is correct and to the best of my knowledge true. I hereby give permission to the
Department of Justice and Constitutional Development to verify the correctness of any of my statements. I know that I can
be prosecuted if I knowingly give false information.
______________________________________________ ______________________
Signature of applicant or the person completing the form Date
on behalf of the person who needs assistance
NOTE
The application form must, after completion, be submitted to the dedicated official –
(a) electronically to the following addresses: TRCeducation@justice.gov.za ; or
(b) by facsimile to 086 476 3777; or
(c) by registered post to the following address: The Head: TRC Unit, The Department of Justice and Constitutional
Development, Private Bag X81, Pretoria, 0001.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

FORM 1: Regulation 10 APPLICATION FOR ASSISTANCE IN (South Africa Department of Justice and Constitutional Development)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 16 March 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document