Isijobelelo A 


OKUBALULEKILE: UKUBHALWA KWESITATIMENDE ESINGAMANGA 
KUYICALA 

IMINININGWANO YOMUNTU OGCWALISA ISIQINISEKO 
Isibongo: _____________________________________________________________________ Amagama aphelele:________________________________________________________________ Inombolo kamazisi: ___________________________________ 
Inhlangano yezepolitiki/isikhungo/uphiko/umzabalazo wenkululeko:  
Ubukhulu ngaphakathi enhlanganweni/esikhungweni/uphiko/emzabalazweni wezepolitiki: 
Ikheli lasekhaya lehhovisi elikhulu lenhlangano/isikhungo/uphiko/umzabalazo wenkululeko:  
Ikheli leposi: 
Inombolo yocingo: (________) __________________________________ Ifekisi: (________) __________________________________ Ikheli leposi le-elekthroniki: _____________________________________________ Mina ___________________________________________________________ (amagama aphelele) ngiyafunga phambi kwe-____________________________________________________________ (igama lenhlangano/ isikhungo/ uphiko/ umzabalazo wenkululeko) ukuthi 





(amagama aphelele omfaki sicelo) obelilunga lenhlangano ebalulwe ngenhla/isikhungo/……/umzabalazo wenkululeko uma i(ama)cala okudingeka athethelelwe njengoba kubekwe esigabeni sesibili sefomu lokufaka isicelo, se(ama)cala elenziwe, nokuthi amacala enziwa ukuze kufezeke izinhloso ezilandelayo zenhlangano/isikhungo/uphiko/nomzabalazo wenkululeko ngesikhathi secala: Ulwazi oluchazwe ngenhla sengiliqinisekisile njengokulandelayo (isib. Ulwazi olutholakale kusigcinimniningwane/ isitatimende esitholakale kulabo fakazi abalandelayo, babe nolwazi ngesigameko njll.) kufanele banikezele ngamagama, amakheli nezinombolo zocingo):_________________________________________________________________________ 

Inhlangano yami/isikhungo/uphiko/nomzabalazo wenkululeko, banomqondo wokuthi kungathandwa ngabantu uma 
(amagama aphelele omfaki sicelo) angaxolelwa ngezizathu ezilandelayo: (amagama agcwele omfaki sicelo) angeke esasabisa noma abe ingozi emphakathini ngalezi zizathu ezilandelayo: 

Nginikezwe umsebenzi yinhlangano yami/ isikhungo/uphiko/umzabalazo wenkululeko wokwenza lesi sitatimende nokunikeza lo msebenzi engezithwese wona egameni lenhlangano. 





*(Le ngxenye kufanele igcwaliswe kuthi ikhasi ngalinye libhalwe izinhlamvu eziqala amagama phambi kom- kanye Kumdali Woxolo noma Inxusa Lombuso) 
Mina____________________________________________________________________________ (Amagama aphelele nesibongo) ngiyafunga ukuthi ulwazi olungenhla luyiqiniso futhi luyilo. 
Isayinwe _________________________ zi-_____ usuku luka-_______________ kunyaka ______ 

Kusayina (Ofungayo) 
1. 	
Uyayazi futhi uyiqonda kahle ingqikithi yalesi sitatimende? 

Impendulo:  _________________________________________ 

2. 	
Ngabe uyaphikisana nokuthatha isifungo esibekiwe? 

Impendulo:  _________________________________________ 

3. 	
Ngabe uthatha isifungo esibekiwe njengesibophezela unembeza wakho? 


Impendulo:  _________________________________________ 
A. 	Ngiyaqinisekisa ukuthi imibuzo ebuzwe ngenhla ibuzwe kimi nokuthi izimpendulo zami kuyo njengoba zivela  ngenhla zibhalwe phambi kwami. 
  ___________________________________________________________      Kusayina Ofungayo 
B. 	Ngiyaqinisekisa ukuthi ofungayo ukwamukele ukuthi uyayazi futhi uyayiqonda ingqikithi yalesi sifungo esafungwa phambi kwami futhi wasayina phambi kwami. 
  ___________________________________________________________      Ijaji/Umfungisi Umfungisi 
Amagama okuqala agcwele nesibongo_________________________________________________________________    (izinhlamvu ezinkulu) 



Ikheli lebhizinisi _________________________________________________________________________________ 
_______________________________________________________________________ (ikheli lomgwaqo alibhalwe) 
Usuku ________________________ indawo _______________________ 
NOMA 
1. 	Ngabe uyiqinisekisa ngokugcwele ingqikithi yalesi sifungo? 
 Impendulo ________________________________________ 
A. 	Ngiyaqinisekisa ukuthi imibuzo ebuzwe ngenhla ibuzwe kimi nokuthi izimpendulo zami kuyo njengoba zivela  
ngenhla zibhalwe phambi kwami. . 
  ___________________________________________________________      Kusayina Ofungayo 
B. 	Ngiyaqinisa ukuthi ofungayo ukwamukele ukuthi uyayazi futhi uyayiqonda ingqikithi yalesi sifungo esafungwa phambi kwami futhi wasayina phambi kwami. 
  ___________________________________________________________      Ijaji/Umfungisi Umfungisi 
Amagama okuqala agcwele nesibongo_________________________________________________________________    (izinhlamvu ezinkulu) 
Isikhundla ________________________________________________________ Selunga ngokwesikhundla kwiRiphabhuliki yaseNingizimu Afrika 
Ikheli lebhizinisi _________________________________________________________________________________ 
___________________________________________________________________ (ikheli lomgwaqo kufanele libhalwe) 
Usuku ________________________ Indawo _______________________ 






