APPLICATION FORM For Office use only:

Student No:
PLEASE COMPLETE OR MARK WITH AN X ALL WHITE AREAS
________________
Programme Name: FASSET/ Women’s Leadership Development Customer No:

________________
Programme Dates: 2024

PERSONAL DETAILS
Surname

First Names (in full)

Preferred name

Dietary Requirements

SA ID

Title (e.g. Mr, Ms) Date of Birth

Home Language Gender Male Female

Physical Adress

Postal Address Postal Code

Contact Number Cell

E-mail Address

Programme Applying for

Executive Management Advancement
Development Programme
Study Preference ( Online,
Face to face @WBS,
Weekends, nights or
weekdays
COMPANY DETAILS
Company

Sector
Is company a FASSET
Levythe Payer or
stakeholder
Submission Documents
(submitted with application to below email address)
Copy Recently Certified ID

Copy of updated CV

Copy of Highest Qualification

Proof of Surname change ( if applicable)
NA
*This is applicable for candidates with ID that may differ
from academic certificates
Applications
Exec.applications@fasset.org.za
Email

Please complete Page 2

 TERMS AND CONDITIONS

Payments Legal Declaration of Indemnity

1. The course is paid for by FASSET
I, the applicant, and I/we the sponsor of the applicant
Fees 1. Acknowledge that the Wits Business School does not accept
1. Wits reserve the right to withhold examination results, certificates or responsibility for damage or loss in respect of property of the applicant
access to the campus until the outstanding accounts are settled in full by brought to Wits Business School by the applicant.
the funder 2. Do hereby indemnify the Wits Business School in respect of any damage
2. The sponsor is solely responsible for the payment of the account. caused by the applicant to the Wits Business School property or to the
property of third parties, whether on or off the Wits Business School
premises, as a result of the applicant’s actions either whilst on the Wits
Cancellation Business School premises or whilst engaged in any activity related to
1. Cancellation are handled in line with agreement between funder and WBS the Wits Business School.
3. Declare that I/we have furnished the Wits Business School with all the
information required to make an informed decision about my admission.
4. Undertake to pay unconditionally all fees payable to Wits Business
School as per the payment terms.

Terms of Enrolment
1. Non-attendance will not result in a reduction of fees, nor will it absolve
the participant or the other signatories from full liability for the payment
of fees.
2. Amendments to the registration contract may only be made with the
written consent of the Wits Business School.
3. The Wits Business School reserves the right to change timetables,
course commencement dates, postpone or cancel tuition in any
course/conference initially advertised and offered, on the basis of
insufficient demand or on any other reasonable ground.
4. The participant agrees to be bound by the rules of due performance.
The Wits Business School reserves the right to exclude the participant
from an examination and to withhold a participant’s examination results
if due performance requirements have not been met, without any way
detracting from the right of the Wits Business School to recover fees
payable.

Next Of Kin

Full Name Cell Number

I hereby certify that the information provided in this contract is accurate and complete in all respects.
I confirm that the student and/or sponsor has read and undertaken the terms and conditions of this
contract, and agrees to be bound by them.

_______________________________ ____________
Signature of Applicant Date Signed

General
How did you hear
about Friend or WBS FASSET FASSET
Friend WBS Mailer
WBS/FASSET Colleague Website Mailer Website
Programme?
If other please
specify

Many thanks