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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-
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.
CLOSING DATE FOR SUBMISSIONS: 30 SEPTEMBER
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. Contact details:
(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..)
* Home address / Home address of other person (if applicable):
* Postal address / Postal address of other person (if applicable):
Telephone Numbers:
Home: ( ) Work: ( ) Cell no:
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 R193 952,00 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.
*
*
*
*
*
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 vulnerable household is a household consisting of four or more members, where:
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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 LEARNER 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
*Yes / No
7. Is the person who needs assistance:
(a) A victim?
(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
(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) .................................................................................
*Yes / No
8. (a) Does the person who needs assistance have any disability?
(b) If yes, give details of the disability:
…………………………………………......................………………………………………………………………………
…………………………………………......................………………………………………………………………………
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: ........................
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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 (Mark the applicable option)
The forms of assistance include payment of school fees, allowances for the purchasing of school uniforms and
boarding and transport allowances.
Grande R Grade 1 9 (General Education) Grade 10 12 (Further Education)
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 whether the amount payable is per
annum or term.)
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.)
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 * Yes /No
require the wearing of a school uniform ?
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.)
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: ………………………..................................
(Attach transport quotation)
2. 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.)
3. Does the person who needs assistance reside in a school hostel? * Yes /No
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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:
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
Member 2:
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
Member 3:
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
Member 4:
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
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Member 5:
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
……………………….............……………………………................................
* Attach an additional page if the space is not sufficient
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
(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.
Attach the following supporting documents:
1. Certified copy of the learner’s birth certificate / ID.
2. Certified ID copy of the learner’s parent / guardian.
3. An affidavit stating the relationship between the TRC-identified victim and the learner.
4. School Uniform quotation.
5. Quotation for boarding if applicable.
6. Quotation for transport if applicable.
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