LEARNER REGISTRATION FORM
Please mark the training intervention for the learner registration with a cross (X)
Internship
Experiential
Learner
(P1 or P2)
TVET
Learner
TVET
Lecturer
Development
Bursary
Application
ABET/AET
Section A: LEARNER DETAILS
(Mandatory for all the registrations)
Surname
Name
(as per RSA ID
document)
Date of Birth
RSA Identity
Number
Is the learner
disabled?
Race
Age
Gender
Yes
No
Please specify the type of
disability if "yes"
Residential
Address
Postal Code
Postal
Address
Postal Code
Municipality
Province
Home Tel.
Number
Work Tel.
Number
Cellular
Number
Fax Number
E-mail
Address
Qualifications
Document Title
Document Number
Page Number
Revision Number
Review: Senior Manager: Client
Services
28 July 2017
Learner Registration Form: Internship, Experiential Learner, TVET Learner, TVET Lecturer
Development, Bursary Application and ABET/AET
CSD-FM-003
Date Complied:
01 November 2008
Page 1 of 3
*Last Revision Date:
01 June 2015
Rev 02
Access:
Controlled
Approved: CEO
*The document with the latest revision date is the current official document
SECTION B: COMPANY DETAILS
 Mandatory for all learner/lecturer placements, experiential learning and internships or any of
the other training interventions where work-integrated or workplace learning is applicable.
 Learners who are employed also need to complete this section, e.g. ABET/AET learners
Company Name
Physical Address
Municipality
Province
Postal Address
Postal Code
Name of contact person
Telephone Number
Fax Number
E-mail Address
Cellular No.
merSETA Chamber
SDL Number
Company
Size
SECTION C: TRAINING PROVIDER/INSTITUTIONAL DETAILS
 This section is mandatory for all the registrations.
Name of Provider
Public
Provider
Provider Registration/
Accreditation/SDL
Number
Physical Address
Postal Code
Telephone Number
Fax Number
E-mail Address
Cellular
Number
Training Site Address
Municipality
Private Provider
Province
Postal Code
Document Title
Document Number
Page Number
Revision Number
28 July 2017
Learner Registration Form: Internship, Experiential Learner, TVET Learner, TVET Lecturer
Development, Bursary Application and ABET/AET
CSD-FM-003
Date Complied:
01 November 2008
Page 2 of 3
*Last Revision Date:
01 June 2015
Rev 02
Access:
Controlled
*The document with the latest revision date is the current official document
SECTION D: DETAILS ABOUT THE TRAINING INTERVENTION
 This section is mandatory for all registrations.
Brief description of the training
intervention
Learner Registration Date
DDMM20YY
Training Intervention Start Date
DDMM20YY
Briefly describe the duration of
the training intervention
Learner Signature
Date
DDMM20YY
Training Provider Signature
Date
DDMM20YY
Company Signature
Date
DDMM20YY
The following documents must be attached to the registration form.
Please mark with a cross (X) whether the documents are attached.
1. A certified copy of the RSA identity document
Yes
No
2. Copies of qualification certificates
Yes
No
3. Bursary registrations only:
Yes
 An acceptance letter from the training institution (TVET, UoT,
University);
 A duly signed bursary agreement between the learner and the SETA
or its contracted agent, and Proof of registration from the institution.
4. Internships and experiential work experience only:
Yes
 A duly signed internship/experiential agreement, and
 A duly signed employment contract between the intern /experiential
learner and the company (employer).
Approved by
merSETA
merSETA
Designation
(Name)
Signature
Date
No
N/A
No
N/A
DDMM20YY
The merSETA Date Stamp
Document Title
Document Number
Page Number
Revision Number
28 July 2017
Learner Registration Form: Internship, Experiential Learner, TVET Learner, TVET Lecturer
Development, Bursary Application and ABET/AET
CSD-FM-003
Date Complied:
01 November 2008
Page 3 of 3
*Last Revision Date:
01 June 2015
Rev 02
Access:
Controlled
*The document with the latest revision date is the current official document