Declaration of parent(s) dotails for NON-SASSA

applicants.
NSFAS
National Shuoet Financal Ad Scheme
This form ls only for those students who claims not to have family details
andior abridged birth certilficate.

APPLICATION FOR FINANCIAL ASSISTANCE TO STUDY AT A PUBLIC UNIVERSITY OR TVET COLLEGE

DEPARTMENT OF SOCIAL DEVELOPMENT OR SCHOOL PRINCIPAL DECLARATION
The Natlonal Student Financial Ald Schene (NSFAS) requires personal information from agencies relating to the omployment staluUS and lovol of
Income of the parents or guardians of the applicant. NSFAS Is committed to ensuring that the personal information oblained from third parlles is
treated confidentially to protect the privacy of the persons whose personal information is made avalable to NSFAS. NSFAS is further committed to
protecting the personal Informatlon and to use that personal Information in a lawful manner. Kindly note that NSFAS Is exempt from processing data
to the extent that it is in pursuance of its publc duty. NSFAS thus reserves the right to validate all information and details provided by the applicant
and guardian against independent third-party data sources.
Iconfirm that by voluntarily submitting any personal information to NSFAS, in any form, it constitutes an indefinite. unconditional and specific consent
for NSFAS to share such personal information with third parties, and to oblain relevant information frorn third parties.
SURNAME, INITIAL S OF STUDENT JAPPLICANT ID NUMBER

NSHAnGASE aao1oaos7oo
CELLPHONE NUMBER

Y To be completed by Student
1,the undersigned ondeka HesangASe (Full Name and Surname of applicant) do hereby declare that
Iconcur with the statements of my guardian below and that the.fbllowing statements are true,
Ido not know my mother/ nor her whereabouts and cannot provide her ID number or any other documents as a means of identification.
b) Ido not know my father/ nor his whereabouts and cannot provide his ID number or any documents as a means of identification.
c)) None of my surviving family know my parents/ nor their whereabouts and cannot provide their ID numbers or any documents as a means of
identification.

By signing this form, Iacknowledge and am aware that if NSFAS disoovers that this declaration Is false, that I will be required to repay all NSFAS
funds for all academic years and may be held criminally liable.
FIRST NAMES (in full, as per your ID document)

SURNAME (as per your ID document)

CONTACT NUMBER
sHAAsE

DATE

SIGNATURE OF STUDENT

¼ To be completed by Guardian
I, the undersigned Thabisile illan Brtlhelezi (Full Name and Surname of guardian);
ID NUMBER OF GUARDIAN

oo oso7 sso
Ido hereby declare that Iconcur with statement by the applicant above, and that the following are true:
a) Ido not know the mother of the student with ID number: OT6ROSTOKO I nor the mother's whereabouts and
cannot provide her ID number or any other documents as a means oidentification.
b) ldo not know the father of the student with ID number O7O5|0STO80 Inor the father's whereabouts and
cannot provide his ID number or any other documents as a means of ldentification.

Please explain the circumstances that led to you becoming the guardian of this Applicant:

Please indicate as of what date youassumed the role of guardian for this Applicant:oo
By signing his form, Iacknowledge and am aware that if NSFAS discovers that this declaration is false, that Iwill be held personally responsible
for all NSFAS costs in respect of this student applicant and may be held criminally liable.
DATE OF SIGNATURE
SIGNATURE
OF GUARDIAN

APP2022V1
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