Application for the evaluation of foreign qualifications

This document also serves as a pro forma invoice

Submission Number: Qualification Holder: ID / Passport number: Date of birth: Gender: Residential address:

201302095021 Samuel Adjei Bati Yeko H2013585 12 Oct 1984 Male Lycopodium Ghana Ltd PMB KIA Accra

Requested by:

MR YEKO (Self) 233243511477 233243511477 engsam777@gmail.com POST OFFICE BOX 193, NIMA-ACCRA GHANA 00233 00233

Telephone: Cell: e-Mail: Postal address:

Banking details: Purpose of application: Account holder: Bank: Branch number: Account number: SAMUEL ADJEI YEKO BARCLAYS BANK 091 1025647

Products / services required Certificate of evaluation, prepared within 20 working days To be posted by registered mail: Other Country Copies Mr. SCK Amedofu, Pilema University College, Post Office Box OD 13, Accra

Number 1 1 1

Unit price R660.00 R115.00 R50.00

Cost R660.00 R115.00 R50.00

R825.00 NEXT STEPS 1 Sign below. 2 Make payment as indicated. 3 Put together qualification documents as indicated. 4 Submit a complete paper application, including this printout, proof of payment and qualification documents, to SAQA. Post to Postnet Suite 248, Private Bag X06, Waterkloof, 0145, or drop off at Ground Floor, SAQA House, 1067 Arcadia Street, Hatfield.

Declaration:

I have completed the application truthfully. The qualification documents enclosed in the application were issued to me according to the nationally prevailing regulations in the country of origin and were obtained by me at the institution(s) stated on the documents. On request I will submit the original documents. I am proficient in the English language and have understood the text. If not, I understand that the onus is on me to have the text translated / interpreted for me at my own cost so that I gain full understanding.

Signed on this day of at

YEKO