APPL ICAT ION FORM - 2019

Web Address: www.k ingswayplace.co .zaEmai l : info@k ingswayplace.co .za

P lease send the fo l lowinginformat ion with your app l icat ion

Copy of IDs/Passport (Applicant and Student)

Proof of Earnings: Payslip or 3 months Bank Statements

Proof of Registration/Acceptance at Place of Study

Letter of Bursar/Sponsor, if Applicable

How d id you f ind out about us?

Off ice use

Yes / NoApproved

Room Number Allocated

MDA Reference Allocated

Room Type

Single Room

Full Name:

ID/Passport No:

Cell Number:

Email Address:

Work Tel. Number:

Spouse deta i ls

I cert i fy that the informat ionprovided is true and correct

Signature:

Date:

Month ly Income

Gross Salary (Applicant): R

Gross Salary (Spouse): R

Other Income (Specify): R

Total Income: R

Student Deta i ls

Title:

First Name:

Surname:

ID/Passport No:

Nationality:

Date of Birth:

Cell Number:

Email Address:

Institution of Study:

Year of Study (2019):

Course:

Parent/Guardian Deta i ls

Title:

First Name:

Surname:

ID/Passport No:

Nationality:

Date of Birth:

Cell Number:

Email Address:

Residential Address:

Postal Address:

Name of Employer:

Occupation:

Work Address:

Work Tel. Number: