British International Distance College Course Application Please complete the following form with as much detail as possible: * Denotes a required field Personal details *ID Number   ID Document Type:   Select Type SA ID document SA Passport Temp SA ID document Non SA ID document Non SA Passport *Surname:   Maiden Name (if applicable):   First Name:   Middle Name:   Initials:   Title:   Select Title Mr Mrs Ms Date of Birth:  Year 19241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997 Month 010203040506070809101112 Day 01020304050607080910111213141516171819202122232425262728293031 Gender:   Select option Female Male Nationality:   Home language:   Province:   Select province Eastern Cape Free Sate Gauteng KwaZulu Natal Limpopo Mpumalanga Nothern Cape Northern Province Western Cape If you are outside the RSA please indicate country:     *Please enter at least one phone number Home phone:   Work phone:   Cell:   Fax:   Email:     Residential Address:               Postal City/Town:   Postal code:     Postal Address:               Postal City/Town:   Postal code:   Work information Are you employed:   Yes No Company:   Monthly income (in Rands):   Select income range R 500R 1000R 1500R 2000R 2500R 3000R 3500R 4000R 4500R 5000R 5500R 6000R 6500R 7000R 7500R 8000R 8500R 9000R 9500R 10000R 10500R 11000R 11500R 12000R 12500R 13000R 13500R 14000R 14500R 15000R 15500R 16000R 16500R 17000R 17500R 18000R 18500R 19000R 19500R 20000R 20500R 21000R 21500R 22000R 22500R 23000R 23500R 24000R 24500Greater than R24 500 Current occupation:   Application details List programme / Course in which you are interested:   Are you applying for finance?:   Yes No Amount of finance applied for (in Rands):   Select amount R 100R 200R 300R 400R 500R 600R 700R 800R 900R 1000R 1100R 1200R 1300R 1400R 1500R 1600R 1700R 1800R 1900R 2000R 2100R 2200R 2300R 2400R 2500R 2600R 2700R 2800R 2900R 3000R 3100R 3200R 3300R 3400R 3500R 3600R 3700R 3800R 3900R 4000R 4100R 4200R 4300R 4400R 4500R 4600R 4700R 4800R 4900R 5000Greater than R5000 Who referred you?:   AOL contact College Other If referred by a College please indicate which:    
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