DUBE TRADEPORT CORPORATION

DTPC BURSARY APPLICATION FORM

(Graduate Development
Program)
2024

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Please print when completing this form. Mark Submit the completed application form and the
appropriate blocks with an “X” Failure to relevant attachments and send to:
complete this application form fully and correctly [email protected]
may prejudice the applicant’s chances of
obtaining a bursary/scholarship. Attention: Solomon Nkosi
PERSONAL PARTICULARS

FIRST NAMES: _____________________________________________________________________

SURNAME: ________________________________________________

IDENTITY NUMBER: _________________________ DATE OF BIRTH:___________________________

POSTAL ADDRESS: _________________________ PHYSICAL ADDRESS: ______________________

___________________________________________ _________________________________________

TELEPHONE NUMBER: (____)_________________ DISTRICT:________________________________

CELL PHONE NUMBER: ______________________ LOCAL MUNICIPALITY:__________________

ALTERNATE NUMBER: _______________________ WARD NUMBER:__________________________

FAX NUMBER:_______________________________ COUNCILLOR: _____________________________

NATIONALITY: ______________________________ MARITAL STATUS:

Single/Married/Divorced/Widowed

GENDER: Male/female DISABILITY: YES/NO___________________

Are you currently employed? YES/NO If yes,

RACE: Black/Coloured/Indian/ White
please elaborate___________________________

Have you ever been convicted of a criminal YES/NO

offence, dismissed from employment or If the answer is yes please furnish full details
requested to resign? on a separate sheet of paper
.

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Have you previously received a Public Service Bursary/scholarship? YES/NO

If yes – until which year? ____________________________

Are/were you in possession of another bursary/scholarship/financial aid? YES/NO

If the answer is yes please indicate the name of the donor:

_______________________________________________________________________________

Obligations attached to bursary/scholarship/financial aid:

_______________________________________________________________________________

Have all the obligations been fulfilled? YES/NO

Name of the grade you will be doing /degree or diploma which you are applying for:

_______________________________________________________________________________

What will the major subjects be for the degree or diploma (if it above matric)?

_______________________________________________________________________________

Number of years you intend studying for (if it is above matric):

_______________________________________________________________________________

Name of the Tertiary institution you intend studying at:

______________________________________________________________________________

Provisional acceptance from the tertiary institution at which you intend studying

Received or Not Received:________________________________________________________

Please attach.

QUALIFICATIONS
Highest standard passed: Name of school attended:

_____________________________________

Town/city:

_____________________________________

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Please indicate the annual gross income of your parent/s or legal guardian should you be dependent
on them during the course of your intended studies (please indicate or tick the relevant option by
putting a cross next to the what is relevant to you):

Indicate if you are a Single Parent / 2 Parents / Guardian

Gross Income bracket (for both parents/guardian): (tick next to the relevant bracket) X
0 – 100 000
100 001 – 400 000
400 001 – 600 000
600 001 – 800 000
800 001 and above

Full name of parent/legal guardian:

_______________________________________________________________________________

Contact details of parent/legal guardian:

Tel Number: ________________________ Cell phone number: ____________________________

Address of parent/legal guardian:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Employer of parent/legal guardian: __________________________________________________

_______________________________________________________________________________

Address of employer of parent/legal guardian:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

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REVIEW, SUSPENSION AND EXTENSION

The Dube Tradeport Corporation Administration reserves the right, at any time and on any terms or
conditions to:

a) review the continuation of the bursary; or

b) suspend the bursary; or

c) having suspended the bursary, reinstate the bursary; or

d) extend the period of the bursary.

DECLARATION
I understand that this application for a bursary is not a loan and declare that the above particulars are
complete and correct.

___________________________________ ________________
SIGNATURE OF APPLICANT DATE

____________________________________ ________________
WITNESS DATE

___________________________________ ________________
WITNESS DATE

SIGNATURE OF PARENT/LEGAL GUARDIAN__________________________________

DATE: _______________________________

___________________________________ ________________
WITNESS DATE

___________________________________ ________________
WITNESS DATE

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FOR OFFICIAL USE:

RECOMMENDATION BY MANAGER: CSI

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

_______________________________ ________________________
NAME SIGNATURE

DATE: ________________________

SUPPORT AND APPROVAL BY RESPONSIBLE EXECUTIVE:

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

_______________________________ ________________________
NAME SIGNATURE

DATE: ________________________

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REQUIREMENTS

Please provide the following with the Scholarship / Bursary Application Form:

1) An originally certified copy of an official statement of previous grade / matric

results as well as official proof of bachelor’s certificate (matriculation
exemption) if it is a requirement for the course of study you intend following.

2) Proof of registration or evidence

3) An originally certified copy of your identity document.

4) Copy of the curriculum (indicating the number of years of study, number of

modules/subjects to be taken) from the academic institution for the intended
course of study.

5) Income and expenditure statement of parent/legal guardian. (Proof of income

must be provided) or a letter from the Department of Labour or an affidavit from
parent/s stating that they are unemployed.

6) Original certified death certificate/s of parent/s (where applicable).

7) Proof of guardianship where the applicant does not have a biological parent.

8) Letter of motivation (explain why you believe you are deserving of a bursary
outlining your circumstances).