MODE OF STUDY

PROPOSED COURSE OF STUDY:


 

First Name:

Other Names:

Last Name:

Date of Birth:

Sex: MaleFemale
NRC Number:

Nationality:

Email Address:

Contact Number:

Contact Address:

Residential Address:

 
Name of Next of Kin:

Relationship with next of kin:

Contact Number:

State any physical disability including serious illness:

 
HOW DID YOU HEAR ABOUT ZAMCOM PROGRAMS? (Please tick):

 
ATTACHMENTS:(Please attach ALL the required documents
Copy of NRC:

GCE or Grade 12 Certificate:

Proof of payment for registration (K100 deposit slip for other Programs or K150 for Degree Programs):

Any other relevant qualification: (ATTACH SCANNED FILLED IN APPLICATION FORM FOR DEGREE PROGRAMS)

 
DECLARATION:
By submitting this form, I declare that the information provided in this form is true and correct to the best of my knowledge.