Private Bag 16004 Tel: +264 61 413 500

Pioneerspark Fax: +264 61 413 512

First & Last Name Employee number

Income Tax Number Full -time
Banking Details Contract
Cell/Office/Home/Phone Nr Contract period (in full)
ID / Passport number Course Name and Credits

CLAIM FORM (Adjunct Faculty)

The claim form can only be processed after all of the above checks and balances have been
quality checked by the Assistant Registrar.
____________________________________________________
1. PERSONAL INFORMATION

FIRST NAME

ERISHER
_______________________________________________________________________

WOYO
LAST NAME________________________________________________________________

0812458161
TELEPHONE______________(H)_________________ (W)___________________(c)
FN999404
ID NUMBER _____________________________TAX 06786444
NO _________________________

2. BANK DETAILS
FIRST NATIONAL BANK
NAME OF BANK ____________________________BRANCH EXCLUSIVE BANKING
_____________________
62251179373
ACCOUNT NO _____________________________ 280174
BRANCH CODE________________

EMPLOYEE NUMBER: ______________________ FULLTIME CONTRACT

24 August 2020
SIGNATURE OF CLAIMANT ___________________________DATE _______________

-----------------------------------------------------------------------------------------------------------------------
FOR OFFICE USE

CLAIM AMOUNT: ____________________ ACCOUNTANT: ____________________

 OFFICER SIGNATURE DATE

Coordinator: Student Support

Coordinator: Examinations

HOD: Academic

Assistant Director

Director

Finance Department

3. PROGRAMME AND MODULE INFORMATION (online lecturing and post exam)

QUALIFICATION: _________________________________________________________________
ESSENTIAL SUPERVISORY PRACTICES TRAINING - UNAM
MODULE/S: _____________________________________________________________________

CODE/S: _____________________________________________________________________

Description Rate Face to face Additional Total Hours Total

Lecturing Hours – Post Amount – N$
Hours – Exam
Online
24 24 11400
All Diploma
level N$475.00
modules

PGDBA level
modules N$500.00

MBA level N$600.00

modules

DBA level N$700.00

modules

11400
Total Amount Payable: N$__________________________