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APPLICATION FORM
CERTIFICATES

Please indicate the applicable form:

APPLICATION FOR THE ISSUING OF A CERTIFICATE/DIPLOMA/DEGREE

APPLICATION FOR THE PRESENTATION OF A CERTIFICATE/DIPLOMA/DEGREE IN ABSENTIA

*R55-00
APPLICATION FOR THE RE-ISSUING OF A CERTIFICATE/DIPLOMA/DEGREE
*R250-00
PRELIMINARY PROOF OF QUALIFICATION
*R35-00
*Note: An administrative fee as determined by the Deputy Vice Chancellor: Resources and Operations, is payable before your application will be
processed

STUDENT NUMBER

FULL NAMES

SURNAME

MAIDEN NAME (If applicable)

IDENTITY NUMBER

POSTAL ADDRESS
(Address to which certificate
must be mailed)

NAME OF QUALIFICATION

REASON FOR THE RE-ISSUING OF CERTIFICATE PLEASE ATTACH AFFIDAVITE

TELEPHONE NUMBER
(H) (W) (CELL)
E-MAIL ADDRESS

................................................ .....................................
SIGNATURE OF APPLICANT DATE
FOR OFFICE USE

RECEIPT NO: DATE: AMOUNT:

FOR OFFICE USE (Re-issuing)

SERIAL NO: SERIAL NO:
CANCELLED CERTIFICATE RE-ISSUED CERTIFICATE SIGNATURE DATE

........................................................................................................ .....................................
REGISTRAR DATE
CERTIFICATE RECEIVED:

................................................ .....................................
SIGNATURE DATE