Instructions

Please read carefully before capturing, signing or submitting this online agreement
Complete all mandatory fields on this agreement
Ensure that information on this agreement is verified before submitting
The following documents MUST be attached:

A certified copy of a valid proof of identification (i.e. Green Barcoded Identity Document, ID Smart Card or Driver’s Licence)

SECTION A: BENEFICIARY PERSONAL INFORMATION

NB: This section must be completed by the programme beneficiary

Titles *

Initials *

Identification Number *

First Name *

Middle Name

Surname *

Date of Birth *

example: 1980-06-21

Age *

Occupation *

Telephone

Cellphone *

Fax

Email *

Next of kin

Name & Surname *

Relationship *

Telephone & Mobile Number *

Race (Check the box on the left) *

Gender (Check the box on the left) *

Home Language *

Disablilities

Are you disabled? (Check the box on the left) *

If Yes, Please state the nature of your disabitity

Seeing? (Check the box on the left) *

Hearing? (Check the box on the left) *

Walking? (Check the box on the left) *

Remembering? (Check the box on the left) *

Nationality

SA Citizenship? (Check the box on the left) *

If No, Please state your country of birth

Name of province where you attended school (High school) *

Name of last school attended (High school) *

Last School Year *

Select Phase you teach *

Name of area where the learner resides *

Name of province where training is taking place *

Name of District Municipality *

Name of Local Municipality *

Physical Address Information

House No./Stand No. *

Street Name *

Name of Suburb/Village/Township. *

Name of City/Town/Tribal Authority *

Type of area. *

Area Code *

Same as above address?

Postal Address Information (If different from above)

Private Bag/P.O Box Number

Name of City/Town/Tribal Authority

Area Code

SECTION B: EMPLOYER INFORMATION

Employer Name

Principal /Subject Advisor *

Employer SDL Number (If Applicable)

Telephone *

Fax

Email *

Name of District Municipality *

Name of Local Municipality *

Physical Address: Street No./Stand No. *

Name of Suburb/Village/Township

Physical Address Area Code. *

Same as above address?

Postal Address Information (If different from above)

Postal Address: Private Bag/P.O. Box Number.

Name of City/Town/Tribal Authority

Postal Code.

NB: This section must be completed by the training provider

Name of Training Provider/Institution

Name and Surname of Contact Person

Training Provider /Institution Physical Address: House/Stand No.

Street Name

Name of Suburb/Village/Township

Name of City/Town/Tribal Authority

Name of District Municipality

Name of Local Municipality

Telephone

Mobile

Telephone

Registration/ Accreditation number

SDL number (If applicable).

NB: This section must be completed by the ETDP SETA designated official

ETDP SETA Programme Number

Output Indicator Number

Project/ Course Title.

Part Qualification/Skills Programme?

SAQA ID Code (If applicable)

NQF Level

Number of Credits (If applicable)

Artisan Related?

Programme Duration

Mode of Delivery

Date of enrolment onto the Programme

Estimated Date of Completion of the Programme

Please upload a copy of your ID document by clicking on the 'choose files' button.

SECTION E: STATEMENT OF COMMITMENT AND SIGNATURES

The beneficiary

I commit to attend the scheduled training and meet all the requirements of the programme.

DISCLOSURE OF PERSONAL INFORMATION

Information provided will solely be used for the ETDP SETA reporting purposes and will not be provided to the third party without the prior consent of the beneficiary. The ETDP SETA commits to handle the beneficiary personal information in accordance with the provisions of the POPI Act.

INDEMINITY

Upon signature of this agreement the training provider and beneficiary shall indemnify and hold harmless the SETA, its officers, employees and agents from and against any loss (including legal costs and expenses) or liability incurred or suffered by any person arising from any claim, demand, action or proceeding by any person where such loss or liability was caused by a willful, unlawful or negligent act or omission of the training provider, its employees, agents or subcontractors.

SECTION A: BENEFICIARY PERSONAL INFORMATION

NB: This section must be completed by the programme beneficiary

Next of kin

Disablilities

Nationality

Physical Address Information

Postal Address Information (If different from above)

SECTION B: EMPLOYER INFORMATION

Postal Address Information (If different from above)

SECTION C: TRAINING PROVIDER/INSITUTION INFORMATION

NB: This section must be completed by the training provider

SECTION D: SKILLS DEVELOPMENT PROGRAMME INFORMATION

NB: This section must be completed by the ETDP SETA designated official

Please upload a copy of your ID document by clicking on the 'choose files' button.

SECTION E: STATEMENT OF COMMITMENT AND SIGNATURES

The beneficiary

DISCLOSURE OF PERSONAL INFORMATION

INDEMINITY