CERTIFICATE OF ACADEMIC ELIGIBILITY

1. To be completed by competitor
Event: ZUSA GAMES (2023)

University THE COPPERBELT UNIVERSITY University code:

Surname KAITE First Name MWILA

Name
Date of Birth 16 07 2001 Place of birth Ndola
Day Month Year
NRC/Passport 559644/61/1 Se F M
number x X

Student number 19150173

Field of study Medicine and Surgery
Year of study 2nd
Graduation year 2027
Faculty School of medicine

Student signature: M. Kaite_ Date:21st March 2023 ___________________

2. To be completed by institution authorities (Academic officer)

I certify that___________________________________is officially registered for and pursuing
a full programme of study leading towards a degree or diploma at the University

Name OFFCIAL SEAL OF THE

Position UNIVERSITY
Sign/Date

3. To be completed by ZUSA EXCO

Name ZUSA
Position SEAL
Sign

To be submitted to NCC before collection of accreditation card

For assistance contact the ZUSA Secretariat 0n 0977601340

Zambia University Sports Association (ZUSA) Accreditation Form