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PO Box 76297, Lynnwood Ridge, South Africa, 0040

Grain Building, 1st Floor, 477 Witherite Street The Willows, Pretoria, South Africa, 0184

Tel. +27 12 807 6686, Fax. +27 12 807 5600 [email protected], www.agbiz.co.za

Vat nr. 4920204684

Application Agbiz Centenary Bursary 2017

Required documentation

1. Completed application form.

2. Copy of your South African ID or any other proof of RSA citizenship.

3. Proof of registration, or letter from head of department confirming qualification of

admission.

4. Study record to date, also stating successful completion of undergraduate degree.

5. Letter of recommendation by academic supervisor or head of department (strictly no

longer than one page).

6. Letter of motivation by the student, stating why he/she needs the bursary and what

the bursary fund will be used for (strictly no longer than one page).

7. Declaration of any other bursary or support programme you benefit from (if relevant).

Note: Failing to submit ALL required documents will result in your application not being considered. APPLICATION FORM (to be completed):

1. Personal details Name : ______Surname : ______ID nr : ______Race : ______Gender : ______Physical address (as from February 2017) : ______Postal address (as from February 2017) : ______Contact number : ______Email address : ______Next of kin : ______Relation : ______Contact number : ______

2. Field of study

Completed education Completed undergraduate degree/diploma : ______University/Institution attended : ______

Completed post graduate degrees/diplomas: ______University/Institution attended : ______Current/Proposed field of study Current/Proposed degree : ______Specialisation field : ______Have you already formulated a topic for your field of study? Yes  No 

If Yes, State the research topic/field of study: ______

If No, State proposed research topic/field of study: ______

Would you like to be guided by Agbiz to formulate a research topic/field of study? Yes  No 

3. Study leader / Promoter / Head of Department Title, name & surname : ______Position : ______Contact number : ______Email address : ______

(In case a study leader / promoter is not yet identified, or chosen, please indicate particulars of the head of department. The study leaders’ details should then be provided as soon as he/she is identified.)

______APPLICANT’S SIGNATURE DATE