<p> PO Box 76297, Lynnwood Ridge, South Africa, 0040</p><p>Grain Building, 1st Floor, 477 Witherite Street The Willows, Pretoria, South Africa, 0184</p><p>Tel. +27 12 807 6686, Fax. +27 12 807 5600 [email protected], www.agbiz.co.za</p><p>Vat nr. 4920204684</p><p>Application Agbiz Centenary Bursary 2017</p><p>Required documentation </p><p>1. Completed application form.</p><p>2. Copy of your South African ID or any other proof of RSA citizenship.</p><p>3. Proof of registration, or letter from head of department confirming qualification of</p><p> admission.</p><p>4. Study record to date, also stating successful completion of undergraduate degree.</p><p>5. Letter of recommendation by academic supervisor or head of department (strictly no</p><p> longer than one page).</p><p>6. Letter of motivation by the student, stating why he/she needs the bursary and what</p><p> the bursary fund will be used for (strictly no longer than one page).</p><p>7. Declaration of any other bursary or support programme you benefit from (if relevant).</p><p>Note: Failing to submit ALL required documents will result in your application not being considered. APPLICATION FORM (to be completed):</p><p>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 : ______</p><p>2. Field of study</p><p>Completed education Completed undergraduate degree/diploma : ______University/Institution attended : ______</p><p>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 </p><p>If Yes, State the research topic/field of study: ______</p><p>If No, State proposed research topic/field of study: ______</p><p>Would you like to be guided by Agbiz to formulate a research topic/field of study? Yes  No </p><p>3. Study leader / Promoter / Head of Department Title, name & surname : ______Position : ______Contact number : ______Email address : ______</p><p>(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.)</p><p>______APPLICANT’S SIGNATURE DATE</p>