NECT

Commitment Form - ETDPSETA

Welcome to the NECT ETDPSETA Commitment form.

INSTRUCTIONS

1. Please read carefully before capturing, signing or submitting this online agreement

2. Complete all mandatory fields on this agreement

3. Ensure that information on this agreement is verified before submitting

4. The following documents MUST be attached:

A certified copy of a valid proof of identification (i.e. Green Barcoded Identity Document, ID Smart Card or Driver’s Licence)

SECTION A: BENEFICIARY PERSONAL INFORMATION

NB: This section must be completed by the programme beneficiary

Title:

Initials

Identification Number

First Name

Middle Name

Surname

Date Of Birth (example: 1980-06-21)

Age

Occupation

Valid occupation required.

Telephone

Mobile Number

Fax

Next of Kin

Name and Surname of Next of Kin

Relationship

Telephone/Mobile Number

Race

African

Coloured

Indian

White

Gender

Male

Female

Home Language

Disabilities

Are you disabled?

Yes

if yes state nature of disability

Seeing?

Yes

Hearing?

Yes

Walking?

Yes

Remembering?

Yes

Nationality

S.A. Citizenship?

Yes

If No, state country of birth

Name of province where you attended school (High school)

Name of last school attended (High school)

Last School Year

Select Phase you teach

Name of area where the learner resides

Name of province where training is taking place

Name of District Municipality

Name of Local Municipality

Physical Address Information

House No./Stand No.

Street Name

Name of Suburb/Village/Township.

Name of City/Town/Tribal Authority

Type of area.

Area Code.

Same as above address?

Postal Address Information (If different from above)

Private Bag/P.O Box Number

Name of City/Town/Tribal Authority

Area Code.

SECTION B:EMPLOYER INFORMATION

Employer Name

Principal /Subject Advisor

Employer SDL Number (If Applicable)

Telephone

Fax

Name of District Municipality

Name of Local Municipality

Physical Address: Street No./Stand No.

Name of Suburb/Village/Township

Physical Address Area Code.

Same as above address?

Postal Address: Private Bag/P.O. Box Number.

Name of City/Town/Tribal Authority

Postal Code.

NB: This section must be completed by the training provider

Name of Training Provider/Institution

Name and Surname of Contact Person

Training Provider /Institution Physical Address: House/Stand No.

Street Name

Name of Suburb/Village/Township

Name of City/Town/Tribal Authority

Name of District Municipality

Name of Local Municipality

Telephone

Mobile

Fax.

Registration/ Accreditation number

SDL number (If applicable).

NB: This section must be completed by the ETDP SETA designated official

ETDP SETA Programme Number

Output Indicator Number

Project/ Course Title.

Part Qualification/Skills Programme?

Yes

SAQA ID Code (If applicable)

NQF Level (If applicable)

Number of Credits (If applicable)

Artisan Related?

Yes

Programme Duration

Mode of Delivery

Date of enrolment onto the Programme

Estimated Date of Completion of the Programme

Please upload a copy of your ID document by clicking on the 'choose files' button.

SECTION E: STATEMENT OF COMMITMENT AND SIGNATURES

The beneficiary

I commit to attend the scheduled training and meet all the requirements of the programme.

DISCLOSURE OF PERSONAL INFORMATION

Information provided will solely be used for the ETDP SETA reporting purposes and will not be provided to the third party without the prior consent of the beneficiary. The ETDP SETA commits to handle the beneficiary personal information in accordance with the provisions of the POPI Act.

INDEMINITY

Upon signature of this agreement the training provider and beneficiary shall indemnify and hold harmless the SETA, its officers, employees and agents from and against any loss (including legal costs and expenses) or liability incurred or suffered by any person arising from any claim, demand, action or proceeding by any person where such loss or liability was caused by a willful, unlawful or negligent act or omission of the training provider, its employees, agents or subcontractors.

Commitment Form - ETDPSETA

INSTRUCTIONS

SECTION A: BENEFICIARY PERSONAL INFORMATION

NB: This section must be completed by the programme beneficiary

Next of Kin

Disabilities

Nationality

Physical Address Information

Postal Address Information (If different from above)

SECTION B:EMPLOYER INFORMATION

SECTION C:TRAINING PROVIDER/INSITUTION INFORMATION

NB: This section must be completed by the training provider

SECTION D: SKILLS DEVELOPMENT PROGRAMME INFORMATION

NB: This section must be completed by the ETDP SETA designated official

SECTION E: STATEMENT OF COMMITMENT AND SIGNATURES

The beneficiary

DISCLOSURE OF PERSONAL INFORMATION

INDEMINITY