Type of Room Required: Select Room Single Room Sharing Room

Student First Name

Student Surname

Student ID Number

Student Date of Birth

Gender Your gender Female Male

Ethnicity Your ethnicity Black Coloured White Indian Asian

Do you have a Disability? Disable? No Yes

Student Cell Number

Student Email

Address

Province Select Provice KwaZulu-Natal Gauteng Eastern Cape Free State Mpumalanga North-West Northern Cape Western Cape Limpopo

City/Town

University/Study Institution

Faculty None Accounting, Auditing Admin, Office Support & Services Agriculture, Forestry, Environmental & Fishing Banking, Finance, Insurance. Stockbroking Chemical, Petrochemical, Oil & Gas Construction, Design, Architecture & Property Education & Training Engineering, Technical, Production & Manufacturing General Management Government & NGO Health, Fitness, Medical & Optometry Hospitality, Hotel, Catering, Tourism & Travel IT & Telecommunications Legal Matriculants/Graduate/No Experience Media, Advertising, PR, Publishing & Marketing Mining Retail, Wholesale & Supply Chain Sales & Purchasing Science & Scientific Research Security Work Textile/Clothing Transport, Logistics & Freight

Year of Study 1st Year 2nd Year 3rd Year 4th Year+

Parent/Guardian First Name and Surname

Parent/Guardian Cell Number

Parent/Guardian Email

Parent/Guardian ID Number

Name of Employer:

Occupation:

Gross Income (Before Deductions):

Nett Income (After Deductions):

Student ID Copy:

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Parent's ID Copy:

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Parent/Guardian Bank Statement:

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Income/Payslip of Parent or Guardian:

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Proof of Address:

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Proof of study registration:

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