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DIE HOëRSKOOL BEN VORSTER : FICA-FORM

This form meets the requirements of the Financial Intelligence Centre Act
(FICA) of 2012.
Complete the form and attach the necessary documentation.
We reserve the right to verify the information.
If you are not a South African citizen, please attach a copy of your residence
permit.
If you are the learner’s guardian you must attach legal proof of guardianship.

Details of Details of Documents to be

Father Mother attached
Surname
Copy of both parents’
Full names identity documents
(if deceased – please
attach relevant
Date of birth
documentation)
Contact
number
ID-number

CURRENT Water & Lights account

Residential not older than 3 months;
address recently signed lease or
rental agreement with a
recognised agent.

Additional information:

Child’s full name and surname:

_____________________________________________________________.

If parents are divorced or separated, please indicate with which parent the child is
resident.

If you have other children currently at Ben Vorster, please list their names and
grades:

______________________________________________________________
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If you have other children currently attending other schools, please complete the
table below:
NAME OF CHILD GRADE SCHOOL

I, ___________________________(Name of parent/guardian) hereby declare that

the information supplied on this form as well as on the application form is true and
correct and that I, by way of my signature hereunder, authorize the Chairperson of
the Governing Body of Hoërskool Ben Vorster or his/her representative to check and
confirm any of the details supplied. I am aware that, should any information supplied
be found to be false, that my application will not be considered and that I may be
found liable of a criminal offence.
I also acknowledge that application for admission does not guarantee enrolment at
Hoërskool Ben Vorster.

Signed at ___________________ on the ________ day of ________, 2021.

Signature of parent/guardian: _____________________________________

For office use only: Verified by ____________________ Date ____________