ANGLO PLATINUM LIMITED BURSARY SCHEME

APPLICATION FORM
NOTES AND INSTRUCTIONS FOR USE PLEASE READ CAREFULLY
BEFORE COMPLETING THE FORM.
01 The closing date for applications for Anglo Platinum Limited bursaries is 15 May and applications received after this date will
not be considered.
02 The minimum selection requirements are Grade 12 with 60% for both Mathematics and Science. Science is not required for
Finance/Accountancy applications.
03 If you have not received correspondence relating to this application from Anglo Platinum Limited by 31 July of the year of
application, you can assume that your application has been unsuccessful.
04 To apply for a bursary, please print out this form and complete it by hand, using a black pen.
05 Read every section, ensure that the information you provide is accurate and complete ALL the sections on the form.
06 Please provide full details of your academic record, including results for the current academic year and attach proof of the
results. These results must accompany this application and must not be submitted separately. Do not attach original documents
in case they get lost. Attach certified copies of the required documents (ID, Grade12 Certificate and tertiary academic results).
07 Incomplete application forms will not be considered. An application is incomplete if all the sections are not filled in and if proof
of academic results and other required documents do not accompany the form.
08 Submit your application to: The Bursary Department
Anglo Platinum Development Centre
P.O. Box 450
KROONDAL
0350
South Africa
OR e-mail scans of the application form and supporting documents to bursaries@angloplat.com, keeping the original
documents in your records
OR apply online via our website at www.angloplatinum.com
OR call us at 014 596 0190.

FOR OFFICE USE ONLY [APPLICANTS DO NOT COMPLETE THIS SECTION]:

DISCIPLINE:

CATEGORY:

CODE:

ANGLO PLATINUM LIMITED BURSARY SCHEME l APPLICATION FORM l Page 1 of 9

HOW DID YOU BECOME AWARE OF THIS BURSARY SCHEME?
PLEASE INDICATE WITH AN X.
ADVERTISEMENT (STATE NAME OF MAGAZINE/NEWSPAPER/BOOK)
CAREER EXHIBITION (STATE WHERE)
TEACHER
PARENT
SCHOOL VISITED BY ANGLO PLATINUM LIMITED REPRESENTATIVE
OTHER (PLEASE SPECIFY)

SECTION 1: APPLICATION DETAILS

State the career you wish to follow:

Name the degree or diploma you intend to study:

Are you currently registered at a University/

YES NO
University of Technology for this course?

Study year for which you will be registered next year (e.g. first, second):

Name of proposed University/University of Technology:

Have you applied for a bursary with

YES NO
Anglo Platinum Limited before?

If yes to the above, state which discipline and when:

Have you applied to other company/ies for a bursary? YES NO

State which company/ies:

SECTION 2: PERSONAL DETAILS

Surname:

First name(s):

Cell number: Telephone number:

E-mail address:

Gender: MALE FEMALE

Date of birth: C C Y Y - M M - D D

ID number:

ANGLO PLATINUM LIMITED BURSARY SCHEME l APPLICATION FORM l Page 2 of 9

SECTION 2: PERSONAL DETAILS [CONTINUED]

Nationality: RSA OTHER If other, please specify:

Do you have a permanent residence permit? YES NO

If you answered yes to the above question, please

state the permanent residence permit number:

Residential address:

Postal address:

MARRIED SINGLE (For accommodation purposes)

Shoe/boot size: Overall/shirt size: XS S M L XL XXL XXXL

(This information is needed should you be invited for a mine visit at one of our operations)

Do you have a disability? YES NO If yes, please specify:

Alternative contact person

Name:

Cell number: Telephone number:

Residential address:

Details of guardian/parent

Name of guardian/parent:

Relationship:

Cell number: Telephone number:

Residential address:

Have either you or your parent/s been or are employed by Anglo Platinum Limited in the past? YES NO

RELATIONSHIP YEAR
NAME DEPARTMENT OCCUPATION
[MOTHER/FATHER] FROM TO

Should you qualify for a preliminary interview, it will take place at one of the centres below. Please indicate with an X the
centre where you could be interviewed. Interviews will take place during June and July.

CAPE TOWN MIDDELBURG POLOKWANE PRETORIA

DURBAN MMABATHO PORT ELIZABETH RUSTENBURG
JOHANNESBURG PIETERMARITZBURG POTCHEFSTROOM WELKOM

ANGLO PLATINUM LIMITED BURSARY SCHEME l APPLICATION FORM l Page 3 of 9

SECTION 3: SECONDARY EDUCATION
Please provide details of the secondary school(s) you attend(ed):

YEAR
NAME OF SCHOOL GRADE COMPLETED
FROM TO

Details of current/last school or tertiary institution

Name:

Physical address:

Telephone number:

Please state your results for Grades 10, 11 and 12. Specify the percentage obtained:

GRADE 10 CLASS GRADE 11 CLASS GRADE 12 CLASS

SUBJECTS HG/SG HG/SG HG/SG
% AVERAGE % AVERAGE % AVERAGE
Mathematics
(Not Maths Literacy)
Science
English
Other subjects:

Kindly request your school to verify the

above with their official stamp:

Have you written your final Grade 12 exams? YES NO

If yes, which year?

SUBJECTS % HG/SG
Mathematics (Not Maths Literacy)

Science

English

Other subjects:

AGGREGATE SYMBOL:

ANGLO PLATINUM LIMITED BURSARY SCHEME l APPLICATION FORM l Page 4 of 9

SECTION 4: TERTIARY EDUCATION

Current

Name of current University/University of Technology:

What academic year are you currently registered in? (Please mark with an X) 1st 2nd 3rd 4th 5th

Student number:

Year commenced: C C Y Y - M M - D D

Number of practical semesters successfully completed:

Degree/Diploma course:

Previous

Have you previously attended an University/University of Technology? YES NO

Name of University/University of Technology:

Student number:

Year commenced: C C Y Y - M M - D D

Degree/Diploma course:

Have you repeated any year of studying? YES NO

If yes, please provide the following information below:

Reason:

Year: C C Y Y

Examination results (Add supplementary sheet if space is insufficient):

NB: ATTACH PROOF OF RESULTS

FIRST YEAR OF STUDY % OBTAINED

YEAR
(PLEASE STATE SUBJECTS) JUNE DECEMBER

SECOND YEAR OF STUDY % OBTAINED

YEAR
(PLEASE STATE SUBJECTS) JUNE DECEMBER

ANGLO PLATINUM LIMITED BURSARY SCHEME l APPLICATION FORM l Page 5 of 9

SECTION 4: TERTIARY EDUCATION [CONTINUED]

THIRD YEAR OF STUDY % OBTAINED

YEAR
(PLEASE STATE SUBJECTS) JUNE DECEMBER

FOURTH YEAR OF STUDY % OBTAINED

YEAR
(PLEASE STATE SUBJECTS) JUNE DECEMBER

Please supply details if you

are repeating any subjects:

SECTION 5: EXTRAMURAL ACTIVITIES

Please supply details of the role you played in:

Extramural activities
at school:

Community activities:

Please state your

interests and hobbies:

Please state any

positions of leadership or
responsibilities that you
have held:

ANGLO PLATINUM LIMITED BURSARY SCHEME l APPLICATION FORM l Page 6 of 9

 SECTION 6: CAREER

Do you currently have a scholarship, bursary or study loan? YES NO

If yes, please provide the following information below:

Name of scholarship, bursary or study loan:

Name of institution it has been awarded by:

Please state the value of the scholarship, bursary or study loan:

Is there a service obligation attached to this scholarship, bursary or study loan? YES NO

Have you been employed since leaving school? YES NO

If yes, please provide details and attach

a record of service or a testimonial:

YEAR
NAME OF EMPLOYER OCCUPATION
FROM TO

Have you ever visited a mine? YES NO

If yes, please provide details

such as when, where and
what your impressions were:

Write a brief statement

setting out clearly why you
have chosen this career:

SECTION 7: ATTACHMENTS
Please attach any notarised copies after this page.

STOP
Before you sign this:

Have you checked your language and all your facts?

Have you completed all the sections?
Have you remembered to attach all relevant documentation?

ANGLO PLATINUM LIMITED BURSARY SCHEME l APPLICATION FORM l Page 7 of 9

DECLARATION
I hereby give full consent to undergo any medical tests/examination required by Anglo Platinum Limited.
01 I confirm that the information contained in this application is, to the best of my knowledge, correct
and truthful and I understand that if it is not, I may be eliminated from consideration in the selection
process. If, after being admitted to the training scheme, any falsehoods or omissions are discovered in
my application, I understand that my Training Agreement may be terminated.
02 I understand that all statements in my application may be investigated and I authorise the organisation
to contact the following persons who might be able to speak about my abilities and suitability for the
bursary for which I have applied:

03 I understand that an investigation of me might include reference checks from my School/University/

University of Technology/previous employer(s). I authorise any School/University/University of
Technology and/or employer, to provide Anglo Platinum Limited with relevant information and opinions
that may be useful in making a decision, and release such persons and organisations from legal
liability in making such statements.
(Please specify persons/institutions you would like us to contact and provide their contact details.)

04 I hereby indemnify Anglo Platinum Development Centre or any Anglo Group Company, their Training
Managers and Training Officials against any claim for illness or accidental injury sustained by me
during a visit to their operations, should I be invited to attend such a visit.

Signature of Applicant:

Date: C C Y Y - M M - D D

ANGLO PLATINUM LIMITED BURSARY SCHEME l APPLICATION FORM l Page 8 of 9

FOR OFFICE USE ONLY
Receipt/Initial screening
Officials name:

Officials
signature:

Decision:

Date: C C Y Y - M M - D D

Comments:

Final screening
Officials name:

Officials
signature:

Decision:

Date: C C Y Y - M M - D D

Comments:

Preliminary interview
Officials name:

Officials
signature:

Decision:

Date: C C Y Y - M M - D D

Comments:

Final interview
Officials name:

Officials
signature:

Decision:

Date: C C Y Y - M M - D D

Comments:

ANGLO PLATINUM LIMITED BURSARY SCHEME l APPLICATION FORM l Page 9 of 9