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Konkola Copper Mines

APPLICATION FORM

SCANNED RECEIPT FOR APPLICATION FEE

FIRSTNAME

SURNAME

OTHER NAME

STUDENT ID

NRC NUMBER

DATE OF BIRTH

CELL NUMBER

PHYSICAL ADDRESS

CHIEF

VILLAGE

PROVINCE

DISTRICT

DISABILITY STATUS

YES NO

DISABILYTY

TPIN

UPLOAD TPIN

UPLOAD PASSPORT SIZE PHOTO

UPLOAD DISABILITY - CARD

UPLOAD STUDENT NRC

FIRSTNAME

SURNAME

OTHER NAME

NRC NUMBER

CELL NUMBER

PHYSICAL ADDRESS

OCCUPATION

SUBJECT 1

POINTS

SUBJECT 2

POINTS

SUBJECT 3

POINTS

SUBJECT 4

POINTS

SUBJECT 5

POINTS

SUBJECT 6

POINTS

UNIVERSITY NAME

DEGREE TYPE

PROGRAMME OF STUDY

DURATION OF PROGRAMME

ACADEMIC YEAR

AGREEMENT

I solemnly declare that all information provided in my HELSB application is accurate and true. I understand that any misinformation may lead to immediate disqualification from the program.

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Konkola Copper Mines

APPLICATION FORM

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