Re-reg  
New  
A P  V  J  JA 


Inombolo Yobulunga :________________ 
UMTAPO WOLWAZI KAMASIPALA WASETHEKWINI 
ISICELO SOBULUNGA SABANTU ABADALA (IMINYAKA EWU 18 NOMA NGAPHEZULU)
kanye nemininingwane yombheki/yomzali
WOMNTWANA OFAKA ISICELO 

Sicela usinike 1) Umazisi wakho/iphasipoti kanye nekhophi yamarekhodi ethu 2) Ubufakazi bekheli lakho olisebenzisayo njengamanje 



ULWAZI OLUMAYELANA NOFAKA ISICELO 
Isibongo : Nkk/Nkk/Nksz (Bhala ngokwehlukanisa) Amagama: (Aphelele) Ikheli lokuposa: Identity Number : 

IMINININGWANE YALAPHO USEBENZA KHONA 
Igama lebhizinisi/lenkampani:
Ikhodi: 
Ikheli lasekhaya: Igama lebhizinisi: 
Ikhodi: Ikheli lebhizinisi: 

Ucingo lwasekhaya: Ikhodi: 
Iselula: Ucingo lwasemsebenzini: 
Ikheli le-e-mail: Ikheli le-e-mail: 

ELINYE IKHELI ELINGASETSHENZISWA IKHELI LALAPHO KUNGATHUNYELWA KHONA Igama lelunga lomndeni, umngani noma umakhelwane ISAZISO UMA KUTHATHWA IZINYATHELO ongekho ekhelini lakho:ZOMTHETHO: 
Igama: 
(Sicela ufake umaka ebhokisini olikhethayo)Ikheli : 
:

Ekhaya Ebhizinisini Eposini
Ikhodi: Ucingo: :
Inamba kamazisi: 
Njengo mkhokhi wama-rates/isakhamuzi/umsebenzi/umfundi endaweni engaphansi kukaMasipala wase Thekwini, ngifaka isicelo sobulunga bomtapo wolwazi. Ngiyavuma ukuthobela imithetho yedolobha, imithetho kanye nezimiso zemitapo yolwazi yesifundazwe saKwaZulu-Natali. Ngiyazibophezela ukubhekana nanoma iyiphi impahla ebolekwe ekhadini lami lobulunga kanye nasekhadini lobulunga lengane yami, ibolekwa yimi noma omunye umuntu, kanye nokukhokha izinhlawulo ezifanele, izindleko zokuthenga lokho okulahlekile kanye nezindleko umtapo wolwazi ongene kuzo ngesikhathi uthenga lezo zimpahla noma ukhokha. Ngiyavuma ukuthobela zonke izidingo zomthetho njengokuba zibekwe kwi-Copyright Act, 1978 (Umthetho No. 98 ka 1978) nezichibiyelo zawo. Ngiyavuma futhi ukuninika isaziso ngokushesha nganoma yiluphi ushintsho lwekheli, ucingo nanoma yimiphi eminye imininingwane engenhla. 

Isiginesha yofaka isicelo: ______________________ Usuku: ______________ 
July 2008 

ISICELO SOBULUNGA SEZINGANE (0-17 IMINYAKA) 

Sicela usinike umazisi wengane ngayinye noma isitifiketi sokuzalwa kanyenamakhophi esizowagcina kumarekhodi ethu. 


Inombolo yobulunga: 
Isibongo : (Bhala ngokwehlukanisa) 
Inombolo kamazisi : 
Igama lesikole : 
Le ngane njengoba ineminyaka eyi-12 noma ngaphezulu, ivumelekile ukuboleka noma yiziphi izincwadi zabadala : 
Yebo Usuku : 
Uhlobo lobulunga : Amagama : 

(Aphelele) Usuku lokuzalwa : Ucingo lwasesikoleni: Isiginesha yomzali/yombheki wengane: 
Cha 

Inombolo yobulunga: 
Isibongo : (Bhala ngokwehlukanisa) 
Inombolo kamazisi : 
Igama lesikole : 
Le ngane njengoba ineminyaka eyi-12 noma ngaphezulu, ivumelekile ukuboleka noma yiziphi izincwadi zabadala : 
Yebo Usuku : 
Uhlobo lobulunga : Amagama : 

(Aphelele) Usuku lokuzalwa : Ucingo lwasesikoleni: Isiginesha yomzali/yombheki wengane: 
Cha 

Inombolo yobulunga: Isibongo : 
(Bhala ngokwehlukanisa) Inombolo kamazisi : 
Igama lesikole : Uhlobo lobulunga : Amagama : 

(Aphelele) Usuku lokuzalwa : Ucingo lwasesikoleni: Isiginesha yomzali/yombheki wengane:
Le ngane njengoba ineminyaka eyi-12 noma ngaphezulu, ivumelekile ukuboleka noma yiziphi izincwadi zabadala : 
Yebo Usuku : 

Cha 
LO KHU KUGCWALISWA YIHHOVISI KUPHELA 
Igatsha/idepho : 
Usuku lokubhalisa : 
Uhlobo lobulunga : 
Usuku lokuphela kobulunga : 
bhekwe ngu : 

Isiginesha 

ye-librarian : Inkomba iqinisekisiwe:
Yebo Cha 

 Inombolo yomsebenzi : Inombolo yomsebenzi : Imininingwane ifakwe ngu : 

Ref. No-310501:GB July 2008 



