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.

2 WDA001 REV04 3 INDUSTRY SUB-SECTOR (OTHER ACTIVITY): 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.

3 Doc No: 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 ).

5 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. 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.

6 Documentation must be kept on site and should be available for validation and quality audits. 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.

7 Doc No: WDA001 REV04 6 ASSESSOR QUALIFICATION PORTFOLIO PROGRESS TOWARDS OBTAINING ASSESSOR QUALIFICATION SITE Registered Assessors (must have achieved a nationally recognised qualification). 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.

8 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.