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FORM 1: [Regulation 11] APPLICATION FOR ASSISTANCE IN (South Africa Department of Justice and Constitutional Development)

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J 944
Department of Justice and Constitutional Development Page 1
REPUBLIC OF SOUTH AFRICA
FORM 1
[Regulation 11]
APPLICATION FOR ASSISTANCE IN RESPECT OF HIGHER EDUCATION AND TRAINING
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 or spouse, may request assistance.
To qualify for assistance-
CLOSING DATE FOR SUBMISSIONS: 30 NOVEMBER
EACH YEAR FOR THE NEXT ACEDEMIC 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. Highest level of
Education:
8. 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 R315 201,00 gross
income per year; or
(b) the person who needs assistance must be a member of a vulnerable household.
(c) the applicant who needs assistance must be enrolled in a public University/TVET College and for Undergraduate studies
ONLY.
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Page 2
9. (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.
10. 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)
11. (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. Highest level of
Education:
8. Contact details:
* Home address / Home address of other person (if applicable):
(State below the address where the person who needs assistance lives 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:
9. 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
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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)
10. (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, including NSFAS
or an institution contemplated in the Skills Development Act or his / her employer, for example, a bursary or any discount or has
been exempted from paying 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
Note that assistance will only be provided in respect of programmes leading to a qualification. The forms of assistance
include fees (such as registration costs, tuition fees, costs relating to student counselling, work placement and other
administrative costs), boarding and transport allowances, a meal allowance, an allowance to purchase textbooks and
a device, an amount to settle a debt at a college or a higher education institution and an allowance when a person
works as part of his or her learnership or apprenticeship.
C.1 ASSISTANCE IN RESPECT OF ADULT EDUCATION AND TRAINING (Reg 5)
Note that the highest level of education offered in terms of category C.1 is similar to Grade 9.
Note further that this form of assistance can only be rendered if you are sixteen years of age or older.
I. Assistance in respect of fees and textbooks:
If assistance is needed in respect of fees and textbooks, complete the following:
1. Year in respect of which assistance is needed: …..........….........
2. Details of centre:
(a) Name of centre: ……………………………………………………................................................................
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Page 4
(b) Address of centre: …………………............................................................................................................
…………………………………………………………………..……..…………….….........................................
(Indicate the physical address, in other words, where the centre is situated.)
3. Total amount of fees payable to centre: ...........................................................
(Attach proof of registration at centre and of the amount payable to the centre. Indicate
whether the amount payable is per annum or subject or module.)
4. Amount needed to purchase textbooks: ……………………………………………
5. Banking details of the centre 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 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 centre where
programme 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. 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 FURTHER EDUCATION AND TRAINING (Reg 6)
I. Assistance in respect of fees:
If assistance is needed in respect of fees, complete the following:
1. Year in respect of which assistance is needed: ..............……….........
2. Details of college:
(a) Name of college: ……………………………………….......................................................……..................
(Bank in question must affix its
stamp here
to confirm the banking details of
the institution/person)
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Page 5
(b) Address of college: ………………….........................................................................................................
……………………………………………………..………………………...……...............................................
(Indicate the physical address, in other words, where the college is situated.)
3. Are the studies in respect of which assistance is needed, to be done on a full-time or part-time
basis or through distance learning?: *Full-time /Part-time /Distance Learning
4. Total amount of fees payable to college: ...........................................................
(Attach proof of registration at college and of the amount payable to the college. Indicate whether the amount payable is per
annum or subject or module.)
5. Banking details of the college 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. 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 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 college where
programme 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.)
(Bank in question must affix its stamp
here
to confirm the banking details of the
college)
(Bank in question must affix its stamp
here
to confirm the banking details of the
institution/person)
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Page 6
5. 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 textbooks:
If assistance is needed in respect of textbooks, complete the following:
1. Amount needed to purchase text books: ..........................................
2. Particulars of the text books to be purchased: …………………………………………………………………………
………………………………………………......…………………………………………………….…………………….
…………………………………………………………………...………………………………………………………….
………………………………………………………………………………...…………………………………………….
(Indicate the name of the author, the title of the book and the price of each book.)
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: ………….…………..………………………..
V. Assistance in respect of meals:
If assistance is needed in respect of meals, complete the following:
1. The cost of accommodation includes the cost for meals: Yes/ No
2. For how many months in the year is the allowance needed: ………..
3. How often should the allowance be paid: ……………………………..
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: ………….…………..………………………..
VI. Assistance in respect of a device:
If assistance is needed in respect of a device, complete the following:
1. Amount needed to purchase a device: ………………
2. Particulars of the device to be purchased:
………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………
(Indicate the name, make, model and price of the device.)
3. Module and Diploma/Degree/Programme registered for:
(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)
(Bank in question must affix its stamp
here
to confirm the banking details of the
institution/person)
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Page 7
……………………………………………………………………………………………………………………………….
(If you require assistance of more than R9 523, 00 to purchase a device that is mandatory for
your programme, learning or training, please ensure that the motivation for the device by the head of the
college on a letter head of the college is attached.)
4. Name and Address of college registered with: ……………………………………
5. 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: ………….…………..………………………..
VII. Assistance in respect of the settling of a debt:
If assistance is needed in respect of the settling of a debt, complete the following:
1. Amount of the outstanding debt: ……………..
(Proof of the debt and the amount thereof must be attached.)
2. In respect of which year is the amount due: ………………..
3. For which qualification is the amount due: ………………….
4. Details of the College:
(a) Name of college: ……………………………………………………………….
(b) Address of college: …………………………………………………………….
(Indicate the physical address, in other words, where the institution is situated.)
5. The person whose debt needs to be settled will be allowed to register with the college in the next academic
semester or year after the settlement: Yes/ No.
(Proof of this statement must be attached.)
6. Banking details of the college / 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 944
Page 8
VIII. Assistance in respect of an assistive device:
If assistance is needed in respect of an assistive device, complete the following:
1. Amount needed to purchase an assistive device: ……………………………………..……………………
(Attach proof of the amount and of the fact that the assistive device is needed)
2. Particulars of the assistive device to be purchased:
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
(Indicate the name, make, model and price of the assistive device.)
3. Module and Diploma/Degree/Programme registered for and which requires the above assistive device:
…………………………………………………………………………………………………………………………….
4. Name and Address of college registered with: ……………………………………………………………………
…………………………………………………………………………………………………………………………….
5. Banking details of the person/ institution 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
IX. Assistance in respect of human support:
If assistance is needed in respect of human support, complete the following:
1. Amount needed for human support: ………………………………………………………….………….……..
2. Details of the human support needed: ……………………………….………………….……………………..
3. Particulars of the person providing human support: ………………………………….……………………..
………………………….…………………………………………………………………………………………………
4. The person providing human support will be staying with the student: Yes/ No
5. For how many months in the year is the allowance needed:……………………………………..………….
6. Banking details of the person/institution 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)
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Page 9
X. Assistance in respect of the settling of a fee debt:
If assistance is needed in respect of the settling of a fee debt, complete the following:
1. Amount of the outstanding fee debt: ……………………………………………..……..
(Proof of the fee debt and the amount thereof must be attached.)
2. In respect of which year is the amount due: …………………………………………..
3. For which qualification is the amount due: ……………………………………………………………….….
4. Details of the College:
(a) Name of College: ……………………………………………………..……………………………………….
(b) Address of College: ………………………………………………………………..…………………………….
………………………………………………………………………………………………………………………
(Indicate the physical address, in other words, where the institution is situated.)
5. The person whose fee debt needs to be settled will be allowed to register with the College in the next
academic semester or year after the settlement: Yes /No
(Proof of this statement must be attached.)
6. Banking details of the College in which 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 HIGHER EDUCATION (Reg 7)
Note that the assistance in C.3 is for persons who have passed grade 12 and want to study at a university or
technicon. Note further that the assistance is limited to undergraduate students only.
I. Assistance in respect of fees:
If assistance is needed in respect of fees, complete the following:
1. Year in respect of which assistance is needed: …....…….........
2. Details of institution:
(a) Name of institution: …………………………………………..………..............................................
(b) Address of institution: …………………..........................................................................................
……………………………………………………………............………………............................................
(Indicate the physical address, in other words, where the institution is situated.)
3. Are the studies in respect of which assistance is needed, to be done on a full-time or part-time
basis or through distance learning?: *Full-time /Part-time /Distance Learning
4. Total amount of fees payable to institution: ...........................................................
(Attach proof of registration at institution and of the amount payable to the institution. Indicate
whether the amount payable is per annum or subject or module.)
(Bank in question must affix its
stamp here
to confirm the banking details of
the institution/person)
J 944
Page 10
5. Banking details of the institution 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. 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 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 institution where
programme 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. 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 textbooks:
If assistance is needed in respect of textbooks, complete the following:
(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)
(Bank in question must affix its
stamp here
to confirm the banking details of the
institution/person)
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Page 11
1. Amount needed to purchase text books: ..........................................
2. Particulars of the text books to be purchased: ………………………………………………………………………
……………………………………………………….......………………………………………………….…………….
……………………………………………………….......……………………………………………………….……….
……………………………………………………….......…………………………………………………….………….
(Indicate the name of the author, the title of the book and the price of each book.)
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: ………….…………..………………………..
V. Assistance in respect of meals:
If assistance is needed in respect of meals, complete the following:
1. The cost of accommodation includes the cost for meals: Yes/ No
2. For how many months in the year is the allowance needed: ………..
3. How often should the allowance be paid: ……………………………..
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: ………….…………..………………………..
VI. Assistance in respect of a device:
If assistance is needed in respect of a device, complete the following:
1. Amount needed to purchase a device: …………..…
2. Particulars of the device to be purchased:
………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………...….
…………………………………………………………………………………………………………………………...….
…………………………………………………………………………………………………………………………...….
(Indicate the name, make, model and price of the device)
3. Module and Diploma/Degree/Programme registered for:
.…………………………………………………………………………………………………………..………………….
(If you require assistance of more than R9 523,00 to purchase a device that is mandatory for your
programme, learning or training, please ensure that the motivation for the device by the head of the college
(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 944
Page 12
on a letter head of the college is attached.)
4. Name and Address of Institution registered with: ……………………………………
5. 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: ………….…………..………………………..
VII. Assistance in respect of the settling of a debt:
If assistance is needed in respect of the settling of a debt, complete the following:
1. Amount of the outstanding debt: ……………..
(Proof of the debt and the amount thereof must be attached.)
2. In respect of which year is the amount due: ………………..
3. For which qualification is the amount due: ………………….
4. Details of the institution:
(a) Name of institution: ……………………………………………………………………………………………….
(b) Address of institution: ………………………………………………………....……………………………...….
…………………………………………………………………………………………………………………………...….
…………………………………………………………………………………………………………………………...….
…………………………………………………………………………………………………………………………...….
(Indicate the physical address, in other words, where the institution is situated.)
5. The person whose debt needs to be settled will be allowed to register with the institution in the next
academic semester or year after the settlement: : Yes/ No
(Proof of this statement must be attached.)
6. 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
VIII. Assistance in respect of an assistive device:
If assistance is needed in respect of an assistive device, complete the following:
1. Amount needed to purchase an assistive device: ………………………..………
(Attach proof of the amount and of the fact that the assistive device is needed)
(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 944
Page 13
2. Particulars of the assistive device to be purchased:
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
(Indicate the name, make, model and price of the assistive device.)
3. Degree registered for and which requires the above assistive device:
……………………………………………………………….…………………………….………………………….
4. Name and Address of institution registered with: ……………………………………………………………
5. 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.
IX. Assistance in respect of human support:
If assistance is needed in respect of human support, complete the following:
1. Amount needed for human support: ……………………..
2. Details of the human support needed: …………………………………………………………………………
3. Particulars of the person providing human support: ………………………………………………..………
4. The person providing human support will be staying with the student: Yes/ No.
5. For how many months in the year is the allowance needed:…………………..…………….
6. 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.
X. Assistance in respect of the settling of a fee debt:
If assistance is needed in respect of the settling of a fee debt, complete the following:
1. Amount of the outstanding fee debt: ………………………………………….….…..
(Proof of the fee debt and the amount thereof must be attached.)
2. In respect of which year is the amount due: ………………………………….……..
(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 944
Page 14
3. For which qualification is the amount due: …………………………………………………………..……….
4. Details of the Institution:
(a) Name of Institution: …………………………………………………………….………………………………….
(b) Address of Institution: ………………………………………………………………….………………………….
………………………………………………………………………………………………………………………..
(Indicate the physical address, in other words, where the institution is situated.)
5. The person whose fee debt needs to be settled will be allowed to register with the Institution in the next
academic semester or year after the settlement: Yes/ No.
(Proof of this statement must be attached.)
6. Banking details of the Institution in whose bank account the money is to be paid:
Name of Account holder: ………………………..……………......
Name of bank: ………………………..…………….......................
Account number: …………………..……………..........................
Branch code: ………………………..……………...........................
______________________________________________ _______________
Signature of applicant or the person completing the form Date
on behalf of the person who needs assistance.
C.4 ASSISTANCE IN RESPECT OF SKILLS DEVELOPMENT (Reg 8)
C.4.1 ASSISTANCE IN RESPECT OF LEARNERSHIP OR APPRENTICESHIP
Note that a person whose application for assistance has been approved will only receive the allowance of R1 750,00
per month (Reg 8(1)(c)) during the work experience component of the learnership or apprenticeship for which he or
she is registered and if he or she complies with the conditions of the learnership agreement entered into with the
employer in terms of the Skills Development Act.
I. Assistance in respect of fees:
If assistance is needed in respect of fees, complete the following:
1. Year in respect of which assistance is needed: ………..................
2. Details of learnership or apprenticeship for which assistance is needed: ..........................................................
.............................................................................................................................................................................
.............................................................................................................................................................................
3. Details of college:
(a) Name of college: …………………………………………..………...............................................................
(b) Address of college: ………………….........................................................................................................
(Indicate the physical address, in other words, where the college is situated)
4. Total amount of fees payable to college: ...........................................................
(Attach proof of registration at college and of the amount payable to the college. Indicate whether
the amount payable is per annum or subject or module)
5. Banking details of the college 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
college)
(Bank in question must affix its
stamp here
to confirm the banking details of
the institution/person)
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Page 15
II. Allowance payable during work experience component of learnership or apprenticeship:
If the allowance payable during the work experience component of a learnership or apprenticeship must
be paid to the person who needs assistance, complete the following:
1. Period and year for which the allowance must be paid: ....................................................................................
2. Details of employer where the person who needs assistance will be working: ………………………….………….
Name of the employer: ………………………………………….............................................................................
Physical address of the employer: …………………………………………………….............................................
…………………………………………………………………………………………………………………………………
3. Contact particulars of the employer:
Telephone number: ………………………..……………............................................
Cellphone number: ………………………………………………………..……….
Fax number: ………………………..……………...........................................
4. Banking details of the college 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 meals:
If assistance is needed in respect of meals, complete the following:
1. The cost of accommodation includes the cost for meals: Yes/ No
2. For how many months in the year is the allowance needed: ………..
3. How often should the allowance be paid: ……………………………..
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: ………….…………..………………………..
IV. Assistance in respect of a device:
If assistance is needed in respect of a device, complete the following:
1. Amount needed to purchase a device: ………………………………
2. Particulars of the device to be purchased:
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………..……….
(Indicate the name, make, model and price of the device.)
(Bank in question must affix its
stamp here
to confirm the banking details of the
college)
(Bank in question must affix its
stamp here
to confirm the banking details of the
institution/person)
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Page 16
3. Module and Diploma/Degree/Programme registered for:
……………………………………………………………………………………………………….………………………..
(If you require assistance of more than R9 523,00 to purchase a device that is mandatory for your programme,
learning or training, please ensure that the motivation for the device by the head of the college on a letter head
of the college is attached.)
4. Name and Address of Institution registered with: ………………………………………………………………………
………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………..
5. 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
V. Assistance in respect of an assistive device:
If assistance is needed in respect of an assistive device, complete the following:
1. Amount needed to purchase an assistive device: ……………………………………….……
(Attach proof of the amount and of the fact that the assistive device is needed)
2. Particulars of the assistive device to be purchased:
…………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………
(Indicate the name, make, model and price of the assistive device.)
3. Programme registered for and which requires the above assistive device:
………………………………………………….…..……………………………………………………………………….
4. Name and Address of Institution registered with: ……………………………………
5. 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
VI. Assistance in respect of human support:
If assistance is needed in respect of human support, complete the following:
1. Amount needed for human support: ………………………………………………………………………....
(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 944
Page 17
2. Details of the human support needed: …………………………………………………………………………….
……………………………………………………………………………………………………………………………..
3. Particulars of the person providing human support: ……………………………………………………………
4. The person providing human support will be staying with the student: Yes/ No.
5. For how many months in the year is the allowance needed:……………………………………..…………….
6. 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
VII. Assistance in respect of the settling of a fee debt:
If assistance is needed in respect of the settling of a fee debt, complete the following:
1. Amount of the outstanding fee debt: …………………………………………………..
(Proof of the fee debt and the amount thereof must be attached.)
2. In respect of which year is the amount due: ………………………………….……..
3. For which qualification is the amount due: …………………………………………………………….………….
4. Details of the Institution:
(a) Name of Institution: ………………………………………………………….………………………………………..
(b) Address of Institution: …………………………………………………………………………………………….
……..…………………………………………………………………………………………………………………..
(Indicate the physical address, in other words, where the institution is situated.)
5. The person whose debt needs to be settled will be allowed to register with the Institution in the next academic
semester or year after the settlement: Yes/ No.
(Proof of this statement must be attached.)
6. 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)
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Page 18
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:
……………………….............……………………………............................
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Page 19
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 by facsimile to 086 476 3777; or
(b) by registered post to the following address: The Head: TRC Unit, The Department of Justice and Constitutional
Development, Private Bag X81, Pretoria, 0001.
Attach the following supporting documents:
1. Certified copy of the student’s birth certificate / ID.
2. Certified ID copy of the student’s parent / guardian.
3. An affidavit stating the relationship between the TRC-identified victim and the student.
4. Quotation for boarding, if applicable.
5. Quotation for transport, if applicable.
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FORM 1: Regulation 11 APPLICATION FOR ASSISTANCE IN (South Africa Department of Justice and Constitutional Development)

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Completed 16 March 2022

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