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ACCREDITATION APPLICATION FORM

TRANSPORT EDUCATION AND TRAINING AUTHORITY SOURCE DOCUMENT Doc No.: WDA001 Ref. ISO 9001 Rev No.: 004 Page No.: Page 1 of 6 ACCREDITATION APPLICATION form Date Compiled: November 2003 Revision Date: November 2004 ACCREDITATION APPLICATION form Compiled By: ETQA Manager Authorised By: CEO Doc No: WDA001 REV04 2 Office use: ACCREDITATION REFERENCE NUMBER: DATE RECEIVED: ACCREDITATION STATUS INITIAL ACCREDITATION EXTENSION OF INITIAL ACCREDITATION SCOPE WITHIN TETA EXTENSION OF INITIAL ACCREDITATION SCOPE OUTSIDE TETA GENERAL INFORMATION PLEASE TICK (9) THE RELEVANT BOX Commercial Provider In-House Provider Community Provider (NGO s, Supported Social Providers) Assessment Centre ORGANISATIONS PAYE REFERENCE NUMBER: APPLICANT INFORMATION: SETA CODE: SETA NAME: CHAMBER/ACTIVITY CODE: INDUSTRY CORE BUSINESS (MAIN ACTIVI)

transport education and training authority ref. iso 9001 rev no.: 004 source document doc no.: wda001 page no.: page 1 of 6 accreditation application form

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Transcription of ACCREDITATION APPLICATION FORM

1 TRANSPORT EDUCATION AND TRAINING AUTHORITY SOURCE DOCUMENT Doc No.: WDA001 Ref. ISO 9001 Rev No.: 004 Page No.: Page 1 of 6 ACCREDITATION APPLICATION form Date Compiled: November 2003 Revision Date: November 2004 ACCREDITATION APPLICATION form Compiled By: ETQA Manager Authorised By: CEO Doc No: WDA001 REV04 2 Office use: ACCREDITATION REFERENCE NUMBER: DATE RECEIVED: ACCREDITATION STATUS INITIAL ACCREDITATION EXTENSION OF INITIAL ACCREDITATION SCOPE WITHIN TETA EXTENSION OF INITIAL ACCREDITATION SCOPE OUTSIDE TETA GENERAL INFORMATION PLEASE TICK (9) THE RELEVANT BOX Commercial Provider In-House Provider Community Provider (NGO s, Supported Social Providers) Assessment Centre ORGANISATIONS PAYE REFERENCE NUMBER: APPLICANT INFORMATION: SETA CODE: SETA NAME: CHAMBER/ACTIVITY CODE: INDUSTRY CORE BUSINESS (MAIN ACTIVITY): TETA ACCREDITATION APPLICATION Doc No: WDA001 REV04 3 INDUSTRY SUB-SECTOR (OTHER ACTIVITY).

2 Trading name: Registered name: Vat reg. No: Company reg. No: SARS Postal address: Postal code: Street address: Postal code: Province/s: Years in current business: Telephone no: Fax number: E-mail address: Contact person 1: Cellphone no: Designation: E-mail address: Contact person 2: Cellphone no: Designation: E-mail address: IF YOU ARE A LEVY PAYER/ACCREDITED BY ANOTHER SETA: SETA Contact: Cellphone no: Designation: E-mail address: Doc No.

3 WDA001 REV04 4 Bank account details Name of account: Account no: Branch code: Bank: Branch: Years held: This information is to assist in confirming financial probity and for electronic banking purposes. Newly established providers - attach a copy of your business plan. Commercial and Itinerant Providers - furnish a certificate from a reputable Chartered Accountant which confirms that the business is in good financial standing and able to carry out the obligations envisaged in the ACCREDITATION process.

4 To enable us to process your information correctly, kindly furnish us with the following details: 1. Do you require single ACCREDITATION for your entire group/organisation? YES NO 2. Would you prefer to have each branch accredited separately? YES NO 3. Would you prefer to have your branches/ sites accredited on a regional basis? YES NO (If you have elected a regional ACCREDITATION system above, please attach a detailed list of organisations/branches/sites in that region that you wish to link for ACCREDITATION ). DECLARATION: I _____ hereby declare that I have not been granted ACCREDITATION for the Scope/Learning Programme/ Unit Standard/Qualification or applied for ACCREDITATION to another Education and Training Quality Assurance Body.

5 I also declare that the primary focus of my business falls within the scope of TETA. I declare that I am authorised to submit this APPLICATION on behalf of _____(Applicant) in terms of a resolution of the Board of Directors/Controlling Body (delete that which is not applicable), a certified copy of which is attached SIGNATURE CAPACITY DATE Doc No: WDA001 REV04 5 ACCREDITATION APPLICATION PLEASE ENSURE THE GENERAL INFORMATION SECTION HAS BEEN COMPLETED BEFORE PROCEEDING TO THIS SECTION Please tick (9) the boxes in the site column. Documentation must be kept on site and should be available for validation and quality audits.

6 TRAINING & ASSESSMENT SITE Provision of NQ Assessment INTERNAL EXTERNAL Scope of NQ Assessment US Code Unit Standard Title AND / OR Provision of Outcomes Based Training and/or Assessment INTERNAL EXTERNAL List Learning Programmes Offered: (Complete the Learning Programme Evaluation Self Assessment form ) 1. 2. 3. 4. 5. 6. 7. 5. 6. 7. Doc No: WDA001 REV04 6 ASSESSOR QUALIFICATION PORTFOLIO PROGRESS TOWARDS OBTAINING ASSESSOR QUALIFICATION SITE Registered Assessors (must have achieved a nationally recognised qualification).

7 INTERNAL EXTERNAL Assessor Name: Registration No: Assessor Name: Registration No: Assessor Name: Registration No: Assessor Name: Registration No: Registered Trainers (must have achieved or national recognised equivalent) INTERNAL EXTERNAL Trainer Name: Registration No: Trainer Name: Registration No: Trainer Name: Registration No: Trainer Name: Registration No: Trainer Name: Registration No: Trainer Name: Registration No: TRAINING/ASSESSING QUALIFICATIONS SITE Registered Site Contact (must have achieved a nationally recognised qualification) INTERNAL EXTERNAL Site Contact Name: Registration No: Registered SDF (for levy payers) INTERNAL EXTERNAL SDF Name: Registration No: Registered Site Quality Assurer INTERNAL EXTERNAL Quality Management Representative: Registration No.


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