APPLICATION FOR INDUSTRIAL ATTACHMENT ALLOWANCE FORM

ZIMBABWE SCHOOL OF MINES

UNIVERSITY/TECHNICAL/POLYTECHNIC/COLLEGE

SECTION A (To be completed by the TRAINEE)

PERSONAL DETAILS

SURNAME ________________________________________________________________________________

FIRST NAMES (IN FULL) ____________________________________________________________________

DATE OF BIRTH ____________________________ GENDER Male Female

I.D. NUMBER _______________________________ STUDENT NUMBER ____________________

CELL NO(S) _________________________________ ________________________________________

RESIDENTIAL ADDRESS ___________________________________________________________________

COURSE BEING UNDERTAKEN (in full) _______________________________________________________

LEVEL (tick) NC 2ND YEAR ND 2ND YEAR HND

ACCOUNT DETAILS

ACCOUNT HOLDER (NAME) _______________________________________________________________

ACC NO. __________________________________________________________________________________

NAME OF BANK _____________________________________ BRANCH _______________________

INDUSTRIAL ATTACHMENT

DURATION OF INDUSTRIAL PLACEMENT:

FROM – DAY ________________ MONTH ________________________ YEAR __________

TO – DAY ___________________ MONTH ________________________ YEAR __________

DECLARATION BY STUDENT

I certify that the information given is true and correct

SIGNATURE _______________________________ DATE ____________________

SECTION B

EMPLOYER’S SECTION (to be completed by a Senior Officer)

NAME OF ORGANISATION/MINE ___________________________________________________________

DEPARTMENT/SECTION TRAINEE IS ATATCHED ___________________________________________

ADDRESS __________________________________________________________________________________

CONTACT PERSON _________________________________________________________________________

CONTACT NO. ___________________________ E-MAIL ADDRESS ____________________________

ALLOWANCES PAID ___________________ FREQUENCY (MONTHLY/WEEKELY) ______________

DURATION OF INDUSTRIAL PLACEMENT:

FROM – DAY ________________ MONTH _________________________________ YEAR _______

TO – DAY ___________________ MONTH __________________________________ YEAR _______

SIGNED AND CERTIFIED CORRECT

________________________________ __________________ _______________________________

NAME (please print) Signature Designation

DATE STAMP

SECTION C (To be completed by the School/Institution/College)

Recommended / Not Recommended

______________________________________________ _______________________ _________________

H.O.D Geology/Mining/Surveying/Metallurgy/Met Assaying Signature Date

Approved/Not Approved

___________________________________________ _________________________ _________________

Training & Operations Manager Signature Date

Examined and Certified Correct/Not Correct

Name ________________________________ Signature ________________ Date ________

Registry