Professional Documents
Culture Documents
FULL PROGRAMME
Send to regadmin@impak.co.za
Complete this form in full to avoid any delays in the registration process.
Application is
processed
Confirmation
via SMS.
We will contact
you if your
application is
incomplete.
On approval,
quote is sent
A quote is
e-mailed to the
account holder.
Learning
material is
ordered
Deposit is paid
Account holder pays
the deposit using the
student number as
reference.
You will be
contacted once
the parcel is
dispatched.
1. Education options
or
Package
Centre name
Language
of
instruction
or
Programme
or
2. Learner
Full names
ID number
Surname
Title
Type of ID
Initials
SA ID
Copy of ID attached
Passport
Yes
Other
Cell number
E-mail
Postal address
Physical address
Street
Street/
PO Box
Suburb
Suburb
City/town
Province
Postal code
Country
Are you currently a learner at Impak?
No
City/town
Country
Province
Postal code
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ID number
Surname
Type of ID
Passport
Other
Fax
Initials
Title
SA ID
Cell number
Alternative
number
E-mail
Postal address
Physical address
Street/
PO Box
Street
Suburb
Suburb
City/town
Province
City/town
Postal code
Country
Province
Postal code
Country
4. Legal guardian
Same person as account holder?
No
Full names
ID number
Surname
Type of ID
SA ID
Passport
Other
Initials
Title
Cell number
Fax
Alternative
number
E-mail
Physical address
Postal address
Street
Street/
PO Box
Suburb
Suburb
City/town
Province
Postal code
Country
City/town
Province
Postal code
Country
5. Delivery method
Home package
A
B
Courier
Collection from
distributor
Impaks preferred method. An additional non-refundable delivery fee is payable as part of the deposit:
R250 for addresses in South Africa and R1 050 for addresses in Namibia. Impak does not deliver to any
other country. Parcel needs to be received during working hours.
Clients can collect learing material in person or via an appointed courier from our distributor in Meadowdale,
Johannesburg. No delivery fee is charged. Compulsory for clients outside South Africa and Namibia. Commercial
invoice provided with parcel. Clients will be contacted once parcel is available for collection.
or
Courier service
Physical address
Street
City/town
Suburb
Province
Country
RSA
Centre package
Learning material for centre learners in South Africa is delivered to the centre free of charge. If the centre is based in Namibia, a nonrefundable fee of R900 is charged for delivery.
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A
B
Once-off
payment
Monthly payments
via EFT/bank
deposit/credit card
Monthly Impakadministered
debit order
General terms:
Banking details and reference used for both debit orders and payments
must be as per invoice.
Payments can be made online via Impaks payment portal.
No cheques or cash.
Credit card payments can be made at Impaks office.
A Once-off payment
I would like to pay my account once-off.
Date:
or
Y Y Y Y / M M / D D
Deposit required
with registration.
I would like to pay my account monthly. I hereby give permission that a credit check can be done, if required. I also confirm my accountability for
the payments described.
Date:
or
Y Y Y Y / M M / D D
Deposit required
order payment
C Monthly Impak-administered
with registration.
Onlydebit
once-off
is valid during
I would like to pay my account monthly via an Impak-administrated debit order.
General information:
Bank charges of R100 will be charged to clients if debit orders are returned unpaid and unpaid debit orders will be deducted on a later date.
Accounts will be debited on the twenty-fifth each month.
If approval process is completed by the fifteenth of the current month, the first debit order will be charged in the current month. If not, the first
payment will be the month thereafter.
A debit order cancellation request must be received in writing before the 15th of the current month to cancel the debit order of the next month.
Account number
Bank
Type of account
Branch
Branch code
I hereby request and authorise Impak Onderwysdiens (Pty) Ltd (Impak) to deduct
from my account with the abovementioned bank (or any other bank or branch to
which I may transfer my account) the monthly instalment set out above or any
variable amount pertaining to this agreement and/or registration form. In the event
that the payment date falls on a weekend or public holiday, I agree that the monthly
instalment may be deducted on the first business day either preceding or following
the payment date. If there are insufficient funds in my account to honour the monthly
instalment/s, I hereby authorise Impak to track my account and re-present the debit
order for payment as soon as sufficient funds are available in my account.
Transmission
Savings
Cheque
If for any reason whatsoever the monthly instalment/s have not been deducted
or have been returned unpaid, I authorise Impak to immediately deduct from my
aforementioned account any such unpaid amounts. I understand that I shall not be
entitled to a refund of amounts deducted while this mandate is in force, and while
the amounts are still legally owing to Impak. I agree that this mandate may only
be cancelled by myself upon provision of 20 (twenty) days written notice to Impak.
Impak may cede/assign this mandate to any third party if the agreement is also
ceded/assigned to that third party. In the absence of such cession/assignment of
the agreement, this mandate may not be ceded/ assigned to any third party.
Date:
Signature of account holder
Y Y Y Y / M M / D D
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7. Additional products
We provide the following products at an additional cost, which is payable at registration.
Select the additional products you would like to register for below.
Bible
Education
Electronic
learning
material
Hard copy
examination
papers
(Home package)
No
Yes
No
Select your
grade
Grade R
or
Select two
languages
Compulsory
subjects
Grade 2
Grade 3
English First
Additional Language
and
Grade 1
or
and
Afrikaans Huistaal
or
Learn and do
English First
Additional Language
or
English First
Additional Language
and
Afrikaans Huistaal
or
Afrikaans Huistaal
or
Afrikaans Eerste
Addisionele Taal
Afrikaans Eerste
Addisionele Taal
Afrikaans Eerste
Addisionele Taal
Mathematics
Mathematics
Mathematics
Life Skills
Life Skills
Life Skills
R4 080
R4 080
R4 080
R3 456
R3 456
R3 456
R2 400
R2 400
R2 400
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Select your
grade
Grade 5
Grade 4
English Home Language
Select two
languages
(at least one
home language)
or
English First
Additional Language
and
Compulsory
subjects
English First
Additional Language
and
Afrikaans Huistaal
or
Grade 6
and
Afrikaans Huistaal
or
Afrikaans Eerste
Addisionele Taal
English First
Additional Language
Afrikaans Eerste
Addisionele Taal
Afrikaans Huistaal
or
Afrikaans Eerste
Addisionele Taal
Life Skills
Life Skills
Life Skills
Mathematics
Mathematics
Mathematics
Social Sciences
Social Sciences
Social Sciences
R6 840
R6 840
R6 840
R5 760
R5 760
R5 760
R3 600
R3 600
R3 600
Grade 7
Grade 8
Select two
languages
(at least one home
language)
Compulsory
subjects
Afrikaans Huistaal
Afrikaans Huistaal
or
and
or
and
Grade 9
Afrikaans Huistaal
or
Creative Arts
Creative Arts
Creative Arts
Mathematics
Mathematics
Mathematics
Natural Sciences
Natural Sciences
Natural Sciences
Social Sciences
Social Sciences
Social Sciences
Technology
Technology
Technology
Optional additional
subject
at extra cost
R10 260
R8 640
R8 640
R8 640
R5 400
R5 400
R5 400
R10 260
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Grade 11
English Home Language
or
and
and
Afrikaans Huistaal
Afrikaans Huistaal
or
or
Compulsory subject
Select your
Mathematics
Life Orientation
Life Orientation
Mathematics
or
Mathematics
or
Mathematical Literacy
Remember to
submit your Grade
10 report card with
this registration
Mathematical Literacy
Accounting*
History
Accounting*
History
Business Studies
Information
Technology*
Business Studies
Information
Technology*
Computer Applications
Technology
Life Sciences**
Computer Applications
Technology
Life Sciences**
Dramatic Arts
Physical Sciences
Dramatic Arts
Physical Sciences
Economics
Religion Studies
Economics
Religion Studies
Engineering Graphics
and Design**
Tourism
Engineering Graphics
and Design**
Tourism
Geography**
Visual Arts
Geography**
Visual Arts
(requires Mathematics)
Hospitality Studies
(requires Mathematics)
Hospitality Studies
or
or
Consumer Studies
Agricultural Management
Practices
Practical
assessment may
involve additional
costs.
Agricultural Sciences
Consumer Studies
Agricultural Management
Practices
Practical
assessment may
involve additional
costs.
Agricultural Sciences
Civil Technology*
Please note: The software required for Computer Applications Technology and Information Technology is not included.
I have familiarised myself with the rules regarding admission and subject choices contained in the Grade 10 12 Critical Enrolment
Conditions document (available on Impaks website under Homeschool, Academic, FET Grades 10 to 12).
I declare that the learner is at the required standard to progress to Grade 10. (The policy dictates that a learner must have achieved
the required standards for successful completion of Grade 9 prior to entering Grade 10.) In the event where a valid report card is not
available, the responsibility resides with me (guardian/parent) and I hereby confirm this learners readiness and compliance with the
Grade 9 standards.
Grade 11
and
I have familiarised myself with the rules regarding admission and subject choices contained in the Grade 10 12 Critical Enrolment
Conditions document (available on Impaks website under Homeschool, Academic, FET Grades 10 to 12).
The learner has successfully completed Grade 10 and the valid, final Grade 10 report card is attached.
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Grade 12
Afrikaans Huistaal
and
or
or
Afrikaans Eerste Addisionele Taal
Compulsory subject
Life Orientation
Mathematics
or
Mathematical Literacy
Accounting*
Engineering Graphics
and Design**
Life Sciences**
Agricultural Sciences
Geography**
Physical Sciences*
Business Studies
History
Religion Studies
Computer Applications
Technology
Information Technology*
Tourism
Economics
Hospitality Studies
or
Consumer Studies
Dramatic Arts
Visual Arts
Agricultural Management Practices
Civil Technology*
Electrical Technology*
Mechanical Technology*
Please note: The software required for Computer Applications Technology and Information Technology is not included.
Grade 12 full programme costs
Home package
Tutor package
Package price
Cost element
N/A
N/A
Grade 10 and
11 report cards
required
School package
The candidate must prove that he/she passed Grade 10 and Grade 11 by submitting valid, final
report cards. The Grade 10 report card is required with this registration. If the Grade 11 final
report card is not yet available, the latest report card can be submitted. The final Grade 11
report card should still be submitted by no later than the end of Febuary 2016.
I have familiarised myself with the rules regarding admission and subject choices contained in the Grade 10 12 Critical Enrolment
Conditions document (available on Impaks website under Homeschool, Academic, FET Grades 10 to 12).
I hereby confirm that the learner successfully completed Grade 10 and Grade 11 and both the valid, final Grade 10 and Grade 11
report cards are attached.
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