NELS N M NDELA UNIVERSITY Section H: Declaration by applicant's parent/legal guardian/surety (To be completed only if the applicant is a dependent. All applicants who are currently at school or who have recently eft school ‘and do/will not have permanent employment must have their legal guardiarVparent of surety complete this section and sign on the next page) (Please note that failure to submit all required documentation including this declaration will delay the processing of your application) Student Number: [2293 Big Brerrenti apes tor [Bachelor of PHaRmacy Name(s) and surname of student: 3 STAIN] Ci [Sial [Maiclet Ch [SIA sek: Details of parent/legal guardian/surety Mane IRB ULELA sua on REP USA. oe \erdyninimcfoetagiguardetrey.. LOR 27D S COF OB] sonesston HOS... Fras. 2, Sleneyey Fre Crst.....Lenden rena eote LET, Tes wltbat ses Col eee fo cot... 0 2-806 TEST. mated... 2p Ran AUR GS. on aii: (2000 Reltonshipto appa ep ther and wnt) nA Eo Eneorsnae nat ctanpommimatteponina U.N Crna. geal Employersaddress. : Postal code ‘Work telephone number: Code Number1. confirm that am the logal guardian ofthe applicant and agree tothe provisions contained inthe declaration ofthe applicant 2. | agree to any change in degree, diploms or module thatthe applicant may make. The university shall not be sponsible ifthe ‘appliant abandons hisher studies or leaves the university. 3. apply on behalf the applicantin my personal capacity frie or he registration as a student atthe unversityand hereby bind myselfes surety and principal co-debtor forall fes due and payable owing tothe unversiy by the applicant. 4 Insofar as itmay be applesble to me, | undertake, should the applicant be admitted tothe university to 4.1 comply with al the rules and regulations ofthe university 42 acquaint myself with ll the rules, regulations and instructions applicable to the qualification for which the applicant enrol. 5. 1 shall be personally liable for payment of all fees, which may become due tothe university in terms ofthis application and | renounce the benefits of excision, division and cession of action should any action be taken by he university forthe recovery of fees ‘owing, due and payable to the university by ether myself or the applicant. 6. _inemnity the university against any claim agains the university arising out of any injuries, ss or illness suffered or contractedby the ‘applicant, myselfor any third party representing myself or the applicant curing the course of or arsing out of his/her studies at the University irespecive of the cause of auch damages, ness or loss 7. undertake not to institute any claim against the university on secount of any injuries or loss suf applicant during the course of or aking during his/her stuces atthe univers. 5. The fees and conditions shall be determined by the Council and are subject to amendment without prior notice. | undertake to pay all fees prescribed by the university in respect of any module for which I register by the due date as well as other fes, which may be ‘owing tothe university. Hurther note and accept lability for payment of interests puted bythe university from time to time inthe ‘event of my fling to pay fees fr which | am lable for bythe prescribed dates. nthe event ofthe university successful inttting, legal ction agaist me forthe recovery of any amounts owing, due and payable or the enforcement of sn legal rights ofthe university, | shallbe liable to pay al legal costs incurred on an attorney and client scale, including collection commission and interest | have, furthermore noted that all accounts in respect ofthe applicant wil be sen to himvber fo check for accuracy and that ti the sad appliant’s duty to make accounts concerned available to me for setlement 1. illness contracted by the 9. agree that the university may provide me with statements of accounts and any other communiqués by way of electronic ‘emmunication through data messages. These data messages may be sent othe cellular umber provided by the student. lam also Prepared to accept such messages at the students university ell address. also accept that such mestages nay be received by Imysef atthe cellar or e-mail contact deta provided by the student nthe "declaration by applicant: section of hisher onine ‘pplication 10, understand thatthe registration ofthe applicant may be cancelled or examination results may be withhelif fl to pay any fees owing, ‘due and payable tothe university in respect of the appicanton the de date without any prejudice to any rights, which the university ‘may have in respect ofthe recovery of such fees, 1. Failure to pay the residence fees by the date stipulated ma 12. Ii the event ofthe university successfull insttuting legal setion against me forthe recovery of any amounts owing, due and payable ‘oF the enforcement of any rights ofthe university shale lable to pa all legal fees on an attorney and chant scale, including collection commission and interest, 13, declare thatthe information supplied by me on this form is, tothe best of my knowled—, true and core: sult inthe applicant being evicted from the residences Sign Here PareNt/LEGAL GUARDIAN/SURETY. # Ft ramett.. Sd 1408, YLGELa. surmame on SA ALKALIS A * on tw.) Signed Pegaso” enbay. ot MAY.....02. AF Signature/thumb print of parent / legal guardian /aurey. NB: A copy ofthe identity document of the parent /logal guardian / surety must be submitted.