1. PERSONAL PARTICULARS OF PARENT

Name of Parent:

Residential Address

Telephone Number

Email

Name of learner for whom application is made

Name(s) of learner(s) at the same public school or at another public school that has not been declared a no fee school.

2. FINANCIAL PARTICULARS OF PARENT

Combined annual gross income

Money received from investment

Profit gained from any form of business

Any other additional financial assistance

School fees for the applicant's child at the school

3. ADDITIONAL INFORMATION

Any other relevant information supplied by the applicant, indicating the inability to
pay school fees owing to personal circumstances, that may lead to conditional
exemption:

If you are unable to pay the school fees and if this application is considered
favourably, what amount would you be prepared to pay per month?