Company Letterhead - DOC - DOC

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					                                Learning Programme Application Form
Please forward all submissions to:
The Regional Manager applicable to you as per the attached list
REGION                       REGIONAL MANAGER           TELEPHONE NUMBER   PHYSICAL ADDRESS
Gauteng                      George Mushaike            012-4304930        1267 Pretorius street
                                                                           Hadefield Office park
                                                                           Block B Ground Floor
                                                                           Hatfield, Pretoria
WESTERN CAPE                 Lana van der               021-442-6700       Ground Floor
                             Westhuizen                                    Old Warehouse Building
                                                                           Black River Park
                                                                           Fir Road, Observatory
KWA ZULU NATAL               Richard Earp-Jones         031-333-8800       Ground Floor
                                                                           Smart Exchange
                                                                           Building
                                                                           5 Walnut Road
                                                                           Durban
LIMPOPO/MPUMALANGA Ignatius Mpe                         013-690-1214       202 Parkmed Centre
                                                                           64 Mandela Street
                                                                           Emalahleni
NORTH WEST/FREE              Motlatsi Letsi             051-447-8443       Lustitia Building
STATE/NORTHERN                                                             133 St Andrew Street
CAPE                                                                       Bloemfontein
EASTERN CAPE                 Joyce Mpongoshe            043-722-3010       08 Malcolm-Ess
                                                                           Office Park
                                                                           Southernwood




                                                Page 1 of 4
Please complete ALL sections


Section A: Company Details:


                                    Application Form
Registered Name
Trading Name
SDL Number                                    Levy Number
Authorised Contact Person and                 Name
                                              Title
Designation

Contact Details                               Tel.
                                              Fax.
                                              Cell.
Physical Address (Head office)
Postal Address (Head office)
e-mail address (contact person) and
an alternate contact person’s details


        Please list the geographical areas where learners will most probably be placed.
        Please provide the % break down of learner demographics (e.g. Black 80%, White 10%, Coloured
         20%).
        Provide the contact details and addresses of branches for workplace evaluation to be conducted by
         the seta (Physical address).
        Provide a list of previous Learning Programme interventions delivered by your company.




                                                Page 2 of 4
SECTION B: Learnerships
(Complete details of listed learnership programmes in the spaces provided)
SETA where                 Qualification ID    Title                           OFO Code    NQF level   Credits   18.1 learners       18.2 learners
learnership is                                                                                                   (number)            (number)
registered




SECTION C: Skills Programmes
(Complete details of listed Skills programmes in the spaces provided)
SETA where                Number of Unit       Title                           OFO Code    NQF level   Credits       18.1 learners    18.2 learners
programme is              Standards                                                                                  (number)         (number)
registered




                                                                             Page 3 of 4
                                                      Application
SECTION D: TRAINING PROVIDER DETAILS:
_______________________________ hereby states that the following accredited training provider will be
contracted to perform all training, assessment and moderation of learners:
Provider Name:
SETA where accredited
Accreditation number
Current accreditation Period
Contact Person
Tel. number
Fax number
e-mail (contact and alternate)


Note: The W&RSETA can not and will not intervene in disputes between Training Providers and
employers.


Please attach the following documents:
        Proof of accreditation of training provider (updated ETQA certificate of accreditation indicating the
         approved programmes).


SECTION E: DECLARATION BY EMPLOYER

I, (full names) in my capacity as (job title) of (name of employer) hereby declare that the above information
is correct and valid. I understand that a misrepresentation on this form could lead to a programme not being
allocated to the employer.

Signed at: _____________________________________________


Signature: _____________________________________________


Date: __________________




                                                  Page 4 of 4

				
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Description: Company Letterhead