Brainline Holdings (Pty) Ltd.

Reg. no.: 2019/463668/07

Director: C Cronje

215 Veronica Street

Montana, Pretoria, 0182
Private Bag X505, Sinoville, 0129

+27 (0) 12 543 5000

Info@brainline.com
www.brainline.com

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

https://www.brainoffline.com/invigilator every year.

Personal details

Title:

First names:

Surname:

ID number:

Marital status: Married Divorced Single Widowed

Contact details

Postal address:

Postal code:

Home address:

Postal code:

Tel no (cell):

Tel no (work):

Please attach a certified copy of your ID.

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Details of student(s) to be invigilated:
(If there are more than five (5) students, a new form must be completed.)

Student

Surname and full names:

Grade: Student number:

S
Relationship to
ID number: student:

Address where invigilation will take place:

Student 2

Surname and full names:

Grade: Student number:

S
Relationship to
ID number: student:

Student 3

Surname and full names:

Grade: Student number:

S
Relationship to
ID number: student:

Student 4

Surname and full names:

Grade: Student number:

S
Relationship to
ID number: student:

Student 5

Surname and full names:

Grade: Student number:

S
Relationship to
ID number: student:

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Confidentiality Agreement
I, ,

ID number: , declare that:

• I will maintain the strictest confidentiality regarding any information or process

related to any examination conducted.
• 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.
• I will not take any material that is of a confidential nature out of the examination
area.
• I 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.
• I undertake to immediately report any breach, or attempted breach, of
examination confidentiality and security of which I become aware to
irregularities@brainline.com.
• I fully understand and accept that, should I make confidential examination
information available to any person without the proper authority or should I,
whether by intent or negligence, allow confidential examination information to
be made available to any unauthorised person, any such actions may lead to
legal and/or criminal proceedings against me.
• I am above 18 years of age, I am literate, and I am not a direct relative of any
student I will invigilate.
• In the instance where I 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 will be brought to the attention of Brainline Learning World in writing,
and I will not proceed to invigilate in such a case without Brainline’s permission.
(Email the request to invigilate such a student to karen@brainline.com.)

Signature: Date:

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 Brainline Holdings (Edms.) Bpk.
Reg. no.: 2019/463668/07
Direkteur: C Cronje

Veronicastraat 215
Montana, Pretoria, 0182
Privaatsak X505, Sinoville, 0129

+27 (0) 12 543 5000

Info@brainline.com
www.brainline.com
Opgedateer: 17 Januarie 2019

TOESIGHOUERREGISTRASIEVORM
Die aangewese toesighouer moet ouer as 18 jaar en geletterd wees, en mag nie ‘n
direkte familielid van die student wees nie.

Gebruik asseblief ‘n swart pen om hierdie vorm in te vul. Maak seker u skrif is
leesbaar.

Hierdie vorm moet elke jaar voltooi en by https://www.brainoffline.com/invigilator

opgelaai word.

Persoonlike besonderhede

Titel:

Voorname:

Van:

ID-nommer:
Weduwee/
Huwelikstatus: Getroud Geskei Ongetroud Wewenaar

Kontakbesonderhede

Posadres:

Poskode:

Woonadres:

Poskode:

Tel no (sel):

Tel no (werk):

Heg asseblief ‘n gesertifiseerde afskrif van u ID aan.

Bladsy 4 van 6
Besonderhede van die student(e) oor wie toesig gehou sal word:
(Indien daar meer as vyf (5) studente is, moet ‘n nuwe vorm ingevul word.)

Student

Van en volle name:

Graad: Studentenommer:
S

ID-nommer: Verwantskap met student:

Adres waar toesig gehou sal word:

Student 2

Van en volle name:

Graad: Studentenommer:
S

ID-nommer: Verwantskap met student:

Student 3

Van en volle name:

Graad: Studentenommer:
S

ID-nommer: Verwantskap met student:

Student 4

Van en volle name:

Graad: Studentenommer:
S

ID-nommer: Verwantskap met student:

Student 5

Van en volle name:

Graad: Studentenommer:
S

ID-nommer: Verwantskap met student:

Page 5 of 6
Vertroulikheidsooreenkoms
Ek, ,

ID-nommer: , verklaar dat:

• Ek sal die strengste vertroulikheid uitoefen met betrekking tot enige inligting of
proses wat verband hou met enige eksamen wat onder my toesig geskryf word.
• Ek sal geen eksamenverwante inligting van enige aard aan enige persoon,
organisasie of die media, oordra of bekend maak tensy so beveel deur ‘n hof
nie.
• Ek sal geen materiaal van ‘n vertroulike aard uit die eksamenarea neem nie.
• Ek verstaan ten volle die behoefte aan akkuraatheid en vertroulikheid in alle
aangeleenthede wat verband hou met en verwant is aan die bewaring en
verspreiding van eksamenmateriaal soos vraestelle, nasienriglyne, eksamen-
boeke, bywoningsregisters en dokumentasie in verband met ongerymdhede.
• Ek onderneem om enige verbreking of gepoogde verbreking van eksamen-
vertroulikheid en sekuriteit waarvan ek bewus word onmiddellik te rapporteer.
• Ek verstaan ten volle en aanvaar dat, indien ek sonder die geskikte magtiging
enige vertroulike eksamen inligting aan enige persoon beskikbaar maak, of
toelaat (hetsy doelbewus of deur nalatigheid) dat enige vertroulike eksamen-
inligting beskikbaar gestel word aan ‘n ongemagtigde persoon, enige sulke
aksies tot vervolging in ‘n siviele en/of kriminele hof kan lei.
• Ek is ouer as 18 jaar, ek is geletterd en ek is nie ‘n direkte familielid van enige
student oor wie ek gaan toesig hou nie.
• Indien ek, my kind, ‘n direkte familielid, ‘n goeie vriend/in of die kind van ‘n goeie
vriend/in vir ‘n eksamen sou inskryf, sal ek sodanige inskrywing skriftelik onder
Breinlyn Leerwêreld se aandag bring, en sal ek nie in so ‘n geval sonder
Breinlyn se toestemming toesig hou nie. (E-pos die versoek om oor so ‘n
student toesig te hou aan fred@brainline.com.)

Handtekening: Datum:

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