2011 Application Form
2011 Application Form
2011 Application Form
Note: A minimum initial payment of R25 000 is to be lodged upon application. If a place is offered and taken up, this is
fully deductible from the tuition fees. If however a place is offered but not taken up, then this is not refundable.
1. Student Information
Last Name
First Names
Gender Male Female
Year Month Day
Date of Birth
Age (1 Jan 2011) years
South African Citizen? Yes No
If so, Identity Number
Please attach a copy of front page of ID book. If not South African please attach a copy of your passport and study permit
Postal Address:
Postal code
Residential Address: Fax no.:
& chosen domicillum
citandi et executandi
Tel Home Student’s cell:
Name Father
Name Mother
Tel Father Home Work Cell
Tel Mother Home Work Cell
Student’s email
Mother’s email
Father’s email
Medical conditions If necessary, please supply BIC with life saving treatment eg. Ventalin for asthmatics
(allergies etc.)
Doctor’s Name
Doctor’s Tel No.
Medical Aid & No.
How did you hear about BIC (Newspaper/Word of Mouth/etc?) _______________________
2. Details of relative and/or friend not living with applicant:
Name:
Residential Address: Fax no.:
& chosen domicillum
Email:
citandi et executandi
Postal Address
Postal Code
Tel Home Cell:
Tel Work
3. Academic information
4. Fees: Whether a course is completed or not by the student, for whatever reason, the
full annual tuition fee is due
Date Date
Documents required for registration:
Completed application form (signed by parent/ guardian and student) Registration Authorised
Completed subject choice list (signed by the Director of studies and the student)
IQ test report or latest Cambridge Results For office use only
Copies of ID/Passport of student Director of Studies
Two ID photographs for student card ……………………………
Copies of ID/Passport of person responsible for fees Date………………………
Minimum initial payment (which is a portion of student’s tuition fees)