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									                                                     APPEALS APPLICATION FORM

  Purpose of this Form:

  The purpose of this form is to lodge an appeal to the AgriSETA should an individual or
  institution be dissatisfied with a decision taken by the AgriSETA. The form should be
  completed and submitted by the appellant who can be:
       An accredited and/or registered provider,
       A learner,
       An assessor
       A moderator, or
       Verifier.

  How to complete this Form:

  1. Sections 1 to 4 should be completed by the appellant, whether an accredited provider,
     a learner, an assessor / moderator / verifier.

  2. Section 5 is for the use of the AgriSETA only and should therefore not be completed.

  3. The appellant should complete all the requested information, which is relevant to
     him/her/the institution.

Section 1: General Information
Kindly complete the information below:
Date of appeal lodged:
Provider accreditation or
registration No.:
Learner registration No.:                             Learner ID
Assessor registration No.:                            Assessor ID
Moderator registration No.:                           Moderator
                                                      ID No.:
Verifier registration No.:                            Verifier ID
                         APPEALS APPLICATION FORM

Section 1: General Information (cont.)
Kindly complete the information below:
Name: (institution or
First name and initials:
Postal address:
                                                                Postal Code:
Street Address:
                                                                Postal Code:
Contact person:

Tel No.:                                                   Fax No:
e-mail address:                                            Cell No.:

Section 2: Categories of Appeal
Kindly select ONE of the following categories by ticking the relevant boxes. Please do not
use the comment column.
The Appeals Policy is applicable to any disputes resulting out           AgriSETA comment
of                                                                Tick      (SETA use only)
1      Accreditation of providers                                   
       a     Registration of assessors and/or moderators            
       b     Approval of learning programmes                        
       c     Monitoring & Auditing of Providers                     
       d     Monitoring & Auditing of Employers                     
       e     Certification of Learners                              
       f     Provision of accredited providers                      
       g     Use of AgriSETA logo                                   
2      Learner                                                      
       a     Withholding of learner certificate                     
       b     Delaying of certification
       c     De-registration of a learner                           
3      Assessor                                                     
       a     SETA withholding registration as an assessor           
       b     SETA withholding registration scope of assessor        
       c     De-registration as an assessor                         
       d     Non-renewal of assessor registration                   
4      Moderator                                                    
       a     SETA withholding registration as a moderator           
       b     De-registration as a moderator                         
       c     Non-renewal of moderator registration                  
5      Verifier                                                     
       a     SETA withholding registration as a verifier            
       b     De-registration as a verifier                          
       c     Non-renewal of verifier registration                   
                           APPEALS APPLICATION FORM

Section 3: Reason for appeal
Please explain the reason for appeal

Section 4: Evidence Attached in support of Appeal
Please list the document/s submitted for review in the Appeal
Annexure A

Annexure B

Annexure C

Annexure D

I (full name)____________________hereby also declare that all the information contained in this
Appeals Application is, to my knowledge, true and correct.

Signed at       on this         day of    in the year of     .

Full Names of person signing:

Designation of person signing:

                           APPEALS APPLICATION FORM

AgriSETA use only

Section 5
5.1    General
Date Received:
Has the Appeals Application been completed in full?                 Yes           No
Has the Acknowledgement of Receipt been sent to the Applicant?      Yes           No
Unique Data Base Number:
Date that the Acknowledgement of Receipt for has been sent to the
Signature of Capturer

5.2  Appeals Committee
Name                                        Contact No:             Role

5.3     Method of Appeal Review
Method of appeal evaluation                 Date Scheduled:         Date Completed:
   Site Visit: Report on Verification Visit
                 Formal appeals hearing
Date of meeting:
Should AgriSETA deem it necessary to constitute a formal appeals hearing, the APPLICANT
will be notified accordingly

Appeals Decision                  Appeal Upheld                          Appeal Failed   
5.4   Summary of appeals decision
                        APPEALS APPLICATION FORM

5.5   Way forward (if applicable)
Actions:                                   By When:

Section 6 Appeals Closure

ETQA representative name            ETQA Representative Signature        Date

APPLICANT representative name       Applicant Representative Signature   Date

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