Reg No.

2001/052594/23
Suite 505, SA Jewelery Centre, 225 Main Street, Johannesburg, South Africa, 2001
Telephone number (International) +27 82 965 7740
(local – within South Africa) 082 965 7740
Fax number (International) +27 86 510 2375
(local – within South Africa) 086 510 2375
Email

corlia@diamondeducation.com
diamondeducation@gmail.com

ENROLLMENT FORM
Title…….

Occupation………………………………..…

Surname………………….………… First Name………………..……………………
Date of Birth………………………… Identity/Passport………………………………
Residential Address ………………….. ………………………..………………………
……………………………………………………………………………………………..
Telephone number……………………………………….…………………

Nationality…………………..…………Language………………..…….….
Special Requirements…………………………………………………………..
Mark Applicable box with an [X]
Rough Diamond Grading and Evaluation Course
Diamond Cutting and Polishing Course
Polished Diamond Grading and Gold Course
Jewellery Design

Please Note: A 50% Deposit is required for booking confirmation as an enrollment fee.
Proof of payment to be emailed to corlia@diamondeducation.com / diamondeducation@gmail.com or
faxed to (International) +27 86 510 2375 / (local – within South Africa) 086 510 2375 Use your name
as a reference.
Signed………………………………….I warrant that all information given in this application and all documents,
which have been or will be signed by me in connection with this application is true and correct.

Bank Details:
FNB Margate
Account name: Corlia Roberts Diamond Education College
Account Number: 62454745921
Branch Code: 220128
SWIFT: FIRNZAJJ
Vat Reg No: 4430206351