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Oxbridge REGISTRATION FORM

Academy

effortless excellence in education

Follow these easy steps and start your journey to success.

STEP 1 - Course Selection

Course name:

Course Code:

I declare that I am fully aware of the accreditation status of the selected course, the certification agent/party and the nature of the course.

STEP 2 - Student details

Date of Birth: Y Y Y Y M M D D

ID/Passport No*:

*Attach proof of ID

Full Names:

Surname: Mr Ms Mrs

Email Address:

Race: African White Coloured Asian

Cell No:

Work No:

Postal Address:

Code:

Delivery Address (Work address preferred):

Code:

Job Status: Unemployed Employed

Occupation:

Company/Work Name:

Highest School Grade Passed*: Year Grade Passed:

Other Qualifications:

*Attach proof of highest grade/other qualifications passed

Student Signature: Date:

Jan 2015

Student Advisor:

STEP 3 - Delivery Options (tick your preference)

Delivery Option Delivery Time Fees X

* Our courier service provider

Registered Post does cover a wide area but

7 - 14 working days Included in course price

(PO Box address) if not available in your area,

Registered Post will apply

* Courier

5 working days Included in course price

(Work address) Preferred

Courier fee for International

Rural areas courier students will be levied

7 - 14 working days Included in course price

(street address must be supplied) separately on a cost basis.

STEP 4 - Registration Fee

Registration fee payable upon registration either by cheque, postal order, bank deposit, electronic transfer or ATM deposit.

Enclose the registration fee when submitting this form and we will send you a Welcome Pack that includes your 1st Study

Unit, Success Study Guide and Student card. International students will be required to pay a deposit of R2400.

*Attach proof of payment

IF YOU ARE: (A) YOUNGER THAN 18 YEARS OR (B) UNEMPLOYED

Parent/Guarantor Details

I approve and confirm this application.

Name: Relation to student:

ID No:

Cell No:

Home No:

Parent/Guardian/Guarantor Signature:

Agreement

I declare that, after entering into this agreement, I still have sufficient means to support myself.

Should I fail to make any payment I owe, the full amount of the balance I owe shall become immediately payable; Oxbridge Academy shall be entitled

to proceed against me for recovery without further notice.

If I am in arrears, or if legal action is instituted, I agree to pay all legal costs, including the charges between attorney and client, collection charges,

tracing costs and commission. I consent in terms of Section 65J of the Magistrates Court Act No 32 of 1944 to an emoluments attachment order to

be issued, without further notice to me, from the court of the district in which my employer resides, carries on business, or is employed, and that the

amount of the emoluments be attached in installments as reflected in my agreement with Oxbridge Academy.

Oxbridge Academy may cede this agreement.

Please note that your information would be part of our database and could be used for Oxbridge Academy related marketing purposes.

CONTACT US

RSA - Tel: RSA - Fax: Fees - Tel: International: Postal address: Physical Address:

021-***-**** 021-***-**** 021-***-**** Tel: +272*-***-**** P.O. Box 12723, 19A Oewerpark,

021-***-**** 086-***-**** 021-***-**** Fax: +272*-***-**** Die Boord, 7613 Rokewood Avenue

Fees - Fax:

086-***-**** Stellenbosch, 7613

E-mail: ****@***************.**.**

021-***-****

Website: www.oxbridgeacademy.co.za

Oxbridge Academy B ank Details

Payment via Bank Deposits

Bank Name ABSA Bank

Branch Code 632005

Account Name Oxbridge Academy

Account Number 407-***-****

Reference Your Tel no & Name

Contact this candidate