o> Brainline aca Updated: 16 January 2019 INVIGILATOR REGISTRATION FORM ‘The nominated invigilator must be over 18 years of age, literate, and cannot be a direct relative of the student Please use a black pen to complete this form. Please write legibly. This form must be completed and uploaded to hltps:/ivwawbrainoffine.com/invigilator every year. Personal details The: we AN First names: ‘Surname: Sec ID number: Marital status: Mariod Single Widowed Contact details Postal address: Postal code: Home address: Postal code: Tol no (cel Tel no (work): Please attach a certified copy of your ID. Page 10f 6v + ym YY vv Yow vos vio Yan VS yo vo vos y NERAL ZIMBABWE CURRENCY E AION iBeueo On REFUNDED VENT OF 2022028. REGISTRAR Savors, ROR ges: = eouenY orn eonzoie ZIMBABWE oar PASSPORTDetails of student(s) to be invigilated: there are more than five (5) students, a new form must be completed.) Student ‘Sumame and fullname: £ LMAO Arar Grade: 4 Student number: & ys Relationship to 1Dnumber: ( ‘student bebo ‘Student 2 ‘Surname and full names: swonnmeee [S| 1 | | | Grade: L Relationship to 1D numbor: student — Student 3 ‘Surname and full names: Grade ‘Student number: Rolationship to IDnumber _ student - Student 4 ‘Sumame and fullnames: - s | Grade: Student number: Relationship to ID number: _ __ student _ Student 5 Sumame and fullnames: erates _ cwsennmer |S | | | | | Relationship to 1D number: student: DreiConfidentiality Agreement (\\ \ ID number: + declare that: + | will maintain the strictest confidentiality rega related to any examination conducted, Jing any information or process + I will not reveal or convey any examination-related information of any nature to any person or organisation or media unless through an order of the court. ‘| willnot take any material that is of a confidential nature out of the examination area * | fully understand the need for accuracy and confidentiality in all matters associated with and related to the storage and distribution of examination material such as question papers, marking guidelines, scripts, attendance registers and irregularity documentation. * | undertake to immediately report any breach, or attempted breach, of examination confidentiality and security of which | become aware to irregulerities@brainiino.com. + | fully understand and accept that, should | make confidential examination information available to any person without the proper authority or should 1, whether by intent or negligence, allow confidential examination information to be made available fo any unauthorised person, any such actions may lead to legal and/or criminal proceedings against me. + Lam above 18 years of age, | am literate, and | am not a direct relative of any student | ill invigilate ‘= Inthe instance where | am or my child, a direct relative, a close friend or children of a close friend is entered as a candidate for an examination, such entry and relationship willbe brought to the attention of Brainline Learning World in writing, and | will not proceed to invigilate in such a case without Brainline’s permis (Email the request to invigilate such a student to karen@brain\ine.com.) Signature: LSD ters