Private Bag X17, Bellville, 7535

South Africa

Tel: +27 (0) 21959 3558

Fax: +27 (0) 21959 3438

Email:

University of the Western Cape

Student Credit Management

Consultant Name & Surname:
STUDENT NUMBER:
STUDENT NAME & SURNAME:
PAYER(S) NAMES & SURNAME:
STUDENT CONTACT NUMBER:
PAYER(S) CELL NUMBER:
PAYER(S) HOME NUMBER:
PAYER(S) WORK TELEPHONE:
PAYER(S) EMAIL ADDRESS:
NEXT OF KIN CONTACT DETAILS:
PTP APPLICATION REQUIREMENTS / Y / N / PENDING INFO/DOC’S / SFC
PERSAL REQUIREMENTS
  1. RECENT SALARY ADVICE/PAYSLIP:

  1. COPY OF ID (PAYER(S)

  1. PROOF OF RESIDENCE:

  1. PERSAL SALARY DEDUCTION

  1. AUTHORISATION (completed & signed by Payer):

DEBIT ORDER REQUIREMENTS / Y / N / SFC
  1. LATEST THREE MONTHS BANK STATEMENT:

  1. COPY OF ID (PAYER):

  1. PROOF OF RESIDENCE

  1. RECENT SALARY ADVICE/PAYSLIP:

  1. DECLARATION SECTION (signed & completed by the Payer):

Private Bag X17, Bellville, 7535

South Africa

Tel: +27 (0) 21959 3558

Fax: +27 (0) 21959 3438

Email:

University of the Western Cape

Student Credit Management

PERSAL SALARY DEDUCTIONS (GOVERNMENT EMPLOYEES ONLY)

I, the undersigned:

  1. Full name & Surname:
  1. Job Title:
  1. Persal number:
  1. Identity number:

NATURE OF EMPLOYEMENT: YES NO

PERMANENT:

YR M D YR M D

CONTRACT / 20 / TO

I ………………………………………… hereby authorize the Accountant of the Department of …(your employer )………………….to deduct monthly with effect from……………...... 20(…………)…………………………………..the instalment of R………………………from my salary and to remit it to the…………………………………………………………(Name of University) Reference number……… …………(Student number) of the University until such time as I settle this authorization in writing, or substitute it with a new authorization.

Total Tuition…………………………………. (This amount represents the total tuition and accommodation fees on or before registration).

TERMS AND CONDTIONS:

No handling fees will be charged.

In the event of death or retrenchment the Persal instruction will be cancelled.

Should I be in a position to settle before the duration of the arrangement, it is my responsibility to inform the University of such developments.

I understand that the Persal salary deduction can only be cancelled/terminated when settlement payment of the tuitions fees is received.

I also understand that I should give notice a month prior, to apply for any amendments or cancellation of the arrangement for the request to be timely processed.

NB!! Employees under administration do not qualify.

Signature of Co-PrincipleRelationship to Student (Mother, Father etc.)

For office use:

Installment not greater than 25% of gross salary / signature
Date signed
Staff Member Name & Surname

Private Bag X17, Bellville, 7535 South Africa

Tel: +27 (0) 21959 3558

Fax: +27 (0) 21959 3438

Email:

University of the Western Cape

Student Credit Management

Declaration Section Agreement

Date:……………………………………………..

Student number:

Student name(s) & Surname:……

Payer name(s) & Surname: ……………………………………………..

I (Name & Surname):…………………………………………………. ID NO:……………………………………………….hereby declare that I am making an arrangement with the Student Credit Management to pay the above student’s outstanding fees until settled.

This declaration section forms part of the payment agreement and serves to confirm the responsible person to pay the outstanding fees indicated in the payment agreement.

  • I acknowledge that the University of the Western Cape may enforce its Fee Policy and no longer apply any leniency which may include deregistration and all related.
  • I give consent that the University of the Western Cape may hand over the account for legal action.
  • I further undertake to notify UWC of any unintentional default on my side and agree that further action may be taken by the University to recover any monthly payments not made by me.

I acknowledge that the arrangement to pay the above amount only serves to facilitate my commitment to settle the debt; it does not include the release of results and certificate of good conduct, unless the account is settled. I further confirm that the contents set out herein is correct and that after payment of the instalment mentioned hereunder I will still have sufficient means/funds left to support my dependents and myself. This agreement and consent is to pay an existing debt where judgement is granted or will be granted.

Signature of Co-Principle
Relationship to Student (Mother, Father etc.)

FOR OFFICE USE:

Date signed
Staff Member Name & Surname