STUDENT REGISTRATION FORM

STUDENT NAME (FORENAMES): ____________________________________ ID NUMBER: ______________

SURNAME: ______________________________________ Highest Qualifications:_____________________

MARITAL STATUS: ________________________________ GENDER: _______________________________

PHYSICAL ADDRESS: ______________________________________________________________________

POSTAL ADDRESS: ________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

NATIONALITY: _______________________________ DATE OF BIRTH: ______________________________

PLACE OF BIRTH: _____________________________________ COUNTRY: __________________________

STUDENT CONTACT DETAILS: Cell: _________________________ Telephone: ______________________

Email address: ____________________________________________________________________________

SPONSHORS DETAILS:

NAME OF SPONSHOR: _____________________________________________________________________

ADDRESS: ________________________________________________________________________________

TELEPHONE: _________________________________ CELL: ______________________________________

E-MAIL: _______________________________________________

SIGNATUTURE OF SPONSHOR: ___________________________

Stamp
NB: Where the sponsor is a company please put the date stamp here!
COURSE CHOICE DETAILS:

Please choose at least three courses according to your priority;

1st Choice; ___________________________________________________________________

2nd Choice; ___________________________________________________________________

3rd Choice; ___________________________________________________________________

MODE OF STUDY (TICK): FULL TIME PART TIME DISTANCE

Important information

Enrolment will be delayed if forms are incomplete or required documents not attached.

1. Certified copy of your ID

2. Certificate of your highest qualification
3. Proof of payment - No enrolment will commence before registration fee & general deposit is paid fully.
i. (Please make sure that copy of deposit slip is readable – use full name as reference)
4. This form is for study entry only.
5. Cancellation will be accepted and shall be facilitated by the Institute refund policy
6. Ensure that you signed the this enrolment form and completed in full
i. Mail to Elsimate Institute at Po Box 70085, Gaborone ELSIMATE INSTITUTE
7. Registration fee in NOT refundable
A/C: 1084650
DEPSOSIT ALL FEES TO THE FOLLOWING
ACCOUNT DETAILS; Branch: Broad-hurst

Bank: Barclays Bank Limited

OR

You may also use the following account for payment purposes;

Bank: First National Bank Limited A/c: 62064341507 Branch: Gaborone Main Code: 281467

Account Name: ElsiMate Holdings (Pty) Ltd

Student Signature___________________________________ Date _______________________

ElsiMate Official ________________________________ Date ___________________________