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Tel: +27 (0)33 343 3301      NPO No. 067-749       PBO No. 930022978    

DONATE NOW Section 18A Compliant

MNB Admission Form

(A) PERSONAL DATA
First Name(s)(*)
Please type your first name(s).

Middle Name(s)(*)
Please type your middle name(s).

Surname(*)
Please type your middle name(s).

Date of Birth(*)
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Age(*)
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Identity Number
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Passport Number
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Date of Issue
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Date of Expiry
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Gender
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Religion
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Nationality
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Preferred Language of communication
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Home Language
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Eye Condition
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Impairment
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Are you a registered Blind Person?
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If Yes, please state your Registration Number
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Educational Qualifications:
(i) Religious
Last Madrassa attended
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Last grade completed and year
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(ii) Secular
Last School attended
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Last grade completed and year
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Address:
Residential
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Postal
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Contact Details:
Telephone
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Fax
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Mobile
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E-mail(*)
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(B) PARTICULARS OF PARENTS
Full Name(s):
Father
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Mother
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Passport / Identity Number:
Father
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Mother
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Occupation:
Father
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Mother
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CONTACT IN CASE OF AN EMERGENCY
Relative / Friend (Next of Kin)
Name
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Contact Details
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Relation
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Name
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Contact Details
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Relation
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(C) PARTICULARS OF FEES
Fees: Fees are
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per month payable by the 1st of each month.

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BUSARY APPLICATION
(i) STUDENT
I,
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(Insert your full names)

hereby authorise the Principal of Madrassa An-Noor for the Blind to be my Shar'ee Wakeel and pay for Madrassa fees, books, audio aids, equipment, etc during my stay at the Madrassa.
 
(ii) PARENT / GUARDIAN
I,
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(Insert your full names)

hereby authorise the Principal of Madrassa An-Noor for the Blind to act as Shar'ee Wakeel on behalf of
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(Insert the full names of the student)

and pay for his/her Madrassa books, audio aids, equipment, etc. during his/her stay at the Madrassa.
(D) DECLARATION
(i) STUDENT
I hereby certify that to the best of my knowledge and beliefs the information stated herein is true and correct. I promise sincerely that I will at all times stay with Islamic Brotherhood, good character and kindness with my teachers, officials, staff and fellow students. I will act according to the rules and regulations of the Madrassa and spend my time in Islamic educational activities. I undertake to refrain from all anti-Islamic ways, dressing, practices and all those acts which are inconsistent with the norms and values of the Madrassa. I also undertake to abide by the Induction Booklet of the Madrassa which I have read and understood.
(ii) PARENT / GUARDIAN
I,
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(Insert your full names)

the Parent / Legal Guardian of
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(Insert the full names of the student)

hereby warrant that the information given herein is true and correct. I acknowledge that the Induction Booklet which I have read and understood binds my child / ward.
 
(E) DECLARATION BY PARENT / GUARDIAN FOR A MINOR
I,
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(Insert your full names)

declare that the information supplied in this application is true and correct and that full details have been furnished
RECOMMENDATION: (For First Time Students Only
Attach Photograph of Yourself
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A Specialist Islamic Institute for the Visually Impaired

Contact Details

Phone :

+27 (0)33 343 3301

Fax:

+27 (0)33 343 3302

Physical Address :

Lot 3 Cedara Road, Cedara, KwaZulu-Natal, South Africa

Postal
Address :

PO Box 4444, Willowton, Pietermaritzburg, KwaZulu-Natal, South Africa, 3200

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