Learner Enrollment Form

Name *

First

Last *

Last

Phone Number

Date Of Birth

ID/Passport No.

Gender

Do you have any disability or declared medically unfit?

Nationality

Write your country of origin.

What is your Highest level of education?

Most courses require basic numeracy and liceracy skills.

What course(s) are you applying for?

Please not that Superlink/Side tipper/ Dangerous goods requires a Code 14 License

When are you starting your course?

Remember you can start at any time. Please indicate the exact date you will be ready to start the course.

Address

Write the address of where you are staying.

Next Of Kin

Emergency Details of the person to contact in case of an emergency

Phone Number

Address

Write the address of where you are staying.

Relationship

How are you related to this person? Brother, Sister, Mother, Father, Uncle, Guardian or Boss

Do you plan to study another course in future?

Yes

If Yes, tell us which one is it below

Which course would you like to do in the future?

Are you currently employed?

Yes

If Yes, tell us write the name of your employer below

Name of the employer.

Are you open to new opportunities?

Should we contact you in case there is a job available which requires your skill?

Which method of payment are you planning to use?

Cash

EFT

Card

Our Banking details are indicated below.

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Our Banking Details

Bank	FIRST NATIONAL BANK (FNB)
Account Holder	Malaika Training Institute (Pty) Ltd
Account Type	Gold Business Account
Account Number	63148187073
Branch Code	250655

Terms and Conditions

I certify that the above information provided by me/us is correct.
I undertake to submit all the documents in original for verification.

Learner Code of Conduct

I will attend all the classes and activities listed on the training schedule for the course for which I am registered.

If I am not able to attend any of the above-mentioned activities due to unforeseen circumstances, I will inform the academy.

If I neglect to do so, I must explain my actions to the disciplinary committee (verbally and in writing).

I will take responsibility for my learning both in the classroom, at home, or practical site.

I will study the sections in my training manual stipulated as self-study.

I will submit my portfolio of projects for assessment on the agreed dates and in the manner prescribed by the facilitator.

I undertake to attend both the classroom and practical training. I understand that an attendance register will be kept by the facilitator and that failure to attend will result in my not being found competent, as I will have failed to complete the required number of training hours.

I have read and agree to the Terms and Conditions.

If you are human, leave this field blank.