Vice President's Office
Form 01
Department of Information Communications Technology
Laptop Computer Scheme - Post-Secondary Student Application
IMPORTANT
The form must be completed in full and be signed. It should be noted that an applicant is eligible for this benefit ONLY ONCE
The applicant should attached only one invoice from a participating supplier.
STUDENT DETAILS
SECTION 1. TO BE COMPLETED BY APPLICANTS - IN BLOCK CAPITALS
NIN
Last name
Other name(s)
Home Address
Contact No
ENROLLMENT DETAILS
SECTION 2. TO BE COMPLETED BY APPLICANTS - IN BLOCK CAPITALS
Institution Name
Course Name
Enrolled Date
DECLARATION
I,
(full name) declare that the information I have provided is true and accurate
and also commit to the indicated Terms and Conditions.
Your Signature
Date
INSTITUTION
SECTION 3. TO BE COMPLETED BY REPRESENTATIVE OF THE INSTITUTION- IN BLOCK CAPITALS
DECLARATION
I
(full name)
(designation)
certified that the above student information provided is true and accurate.
Signature
Institution
Stamp
Date
DICT Use Only
It should be noted that once the application, receipt and invoice have been submitted, DICT will NOT be accept
any other submission by the same person.
Application received by: (Name)
Signature
Date
Cheque No
Delivered to
Signature
for the amount of (SR)
On
Terms and Conditions
1. Shall agree to benefit from the scheme ONLY ONCE.
2. Shall choose a supplier from the list of the suppliers participating in the scheme from which to purchase the laptop.
(participating supplier list available from the DICT website http://www.ict.gov.sc )
3. Shall take full responsibility for the maintenance or replacement (e.g. in case of theft or loss) of the laptop and shall have no
recourse from the Government in any eventuality.
4. Shall, upon signature of the form agree to abide by the process detailing the scheme.
5. Shall agree that the payment made (excluding the SR 3,000 from SSB) to the supplier for the laptop is non-refundable.