LIVINGSTONE HIGH SCHOOL

SUPPORTING DOCUMENTATION AND OTHER IMPORTANT INFORMATION PERTAINING TO AN

APPLICATION FOR EXEMPTION

SUPPORTING DOCUMENTATION REQUIRED

1. Particulars of BOTH natural parents/persons accepting responsibility for fees are a pre-requisite (regardless of
marital status and divorce agreements). In the event of legal guardianship, please provide evidence thereof.
Copies of ID’s of both individuals are required.
2. If one or more parents is/are unemployed a sworn affidavit to that effect must be attached and any other
supporting documentation e.g. documentation from the Unemployment Insurance Fund. SASSA cards need to be
accompanied by a letter from Social Services indicating who the financial aid is in favour of i.e. parents name if
pension/disability grant or children’s name if child support grant. Copies of the SASSA card alone will be
considered insufficient information.
3. Where a parent is deceased, a death certificate must be provided.

4. Documentation to prove Gross Annual Income

a) For Employees:

IRP5/IT3A and salary advice for 3 recent months and latest income tax assessment;

b) For Business Income/Self Employed Persons:

A copy of the last available management accounts and the latest income tax assessment, also indicate on the
application the nature of the business

c) Last 3 months bank statements on ALL BANK ACCOUNTS – business, personal, credit, savings and
investments etc.
d) Disclosure of any rental income and interest or dividends on investments

5. Other documentation required

- List of assets and liabilities
- List of current monthly expenses (page 6)
- Any additional information requested by the SGB once the exemption form has been submitted, in
order to finalise the assessment will be communicated to you via e-mail preferably (in order to
reduce costs- should you not have an email address, a note will be sent home with the learner.)
Please ensure that the contact details supplied on the exemption forms are correct, as the treasurer
will be using this information to contact you should a home visit be required.

OTHER IMPORTANT INFORMATION

1. PAYMENT OF SCHOOL FEES MUST CONTINUE WHILST YOUR EXEMPTION APPLICATION IS BEING PROCESSED.
2. The SGB reserves the right to verify any information supplied. It is a criminal offense to provide false information.
3. Please ensure that the receipt of your application is documented and that you receive a reference number. Forms
must be returned on or before the last day of the Term 1.
4. Where documentary proof is not provided your application will be returned to you for completion and this will
cause a delay in finalising your application.
5. In addition to the application and documentation, the SGB may request a personal interview at your place of
residence to assist both the school and the applicant with the assessment.
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 Exemption application Annexure B

CONFIDENTIAL

This form must be completed and signed before a Commissioner of Oaths before being
submitted for consideration

Date Returned: Reference Number:

Note: Particulars of both parents re a pre-requisite

PERSONAL PARTICULARS OF NATURAL PARENT/GUARDIAN #1

Surname
First Name
Residential Address

ID Number
Contact Details
Home
Work
Self Employed Y/N
Nature of Business
Business Name
Cell
Fax
E-mail
PERSONAL PARTICULARS OF NATURAL PARENT/GUARDIAN #2
Surname
First Name
Residential Address

ID Number
Contact Details
Home
Work
Self Employed Y/N
Nature of Business
Business Name
Cell
Fax
E-mail

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NAME AND GRADE OF ELDEST LEARNER AT LIVINGSTONE HIGH SCHOOL
Surname
First Name
Grade
Residential Address

LEARNER #1 AT THIS PUBLIC SCHOOL OR AT ANOTHER PUBLIC SCHOOL THAT HAS NOT
BEEN DECLARED A NO FEE SCHOOL
Name and Surname of Learner
ID Number
Amount of School fees
Other fees charged (specify what for)
Name of School
Telephone number of School
LEARNER #2 AT THIS PUBLIC SCHOOL OR AT ANOTHER PUBLIC SCHOOL THAT HAS NOT
BEEN DECLARED A NO FEE SCHOOL
Name and Surname of Learner
ID Number
Amount of School fees
Other fees charged (specify what for)
Name of School
Telephone number of School
LEARNER #3 AT THIS PUBLIC SCHOOL OR AT ANOTHER PUBLIC SCHOOL THAT HAS NOT
BEEN DECLARED A NO FEE SCHOOL
Name and Surname of Learner
ID Number
Amount of School fees
Other fees charged (specify what for)
Name of School
Telephone number of School
LEARNER #4 AT THIS PUBLIC SCHOOL OR AT ANOTHER PUBLIC SCHOOL THAT HAS NOT
BEEN DECLARED A NO FEE SCHOOL
Name and Surname of Learner
ID Number
Amount of School fees
Other fees charged (specify what for)
Name of School
Telephone number of School

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FINANCIAL PARTICULARS OF PARENTS/GUARDIANS
(Income of both Parents/Guardians must be declared)
Parents must supply the following:
Combined annual gross income (before deductions- refer note 1/2/3) R

Money Received from investment (see documents required note 1/2/3) R

Profit gained from any form of business (see documents required note R
1/2/3)

School fees of learner at Livingstone High School R

Additional monetary contributions paid by the parents, in relation to a R

learners participation in any programme at this school (specify)

ADDITIONAL INFORMATION

Any relevant information supplied by the applicant, indicating the inability to pay school
fees owing to personal circumstances, that may lead to conditional exemption.

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 Gross Monthly Income R……………………………………………………..

Minus deductions i.e. PAYE, UIF, Pension R……………………………………………………..

Nett Monthly Income R……………………………………………………..

Average monthly Expenditure

BOND/RENT

RATES AND SERVICES

TELEPHONE

GROCERIES

MEAT/ FISH
DAIRY PRODUCTS

MEDICAL EXPENSES

ENTERTAINMENT

POCKET MONEY FOR LEARNERS

HP TRANSACTIONS
DATE OF SETTLEMENT

MISCELLANEOUS (SPECIFY)

Total Monthly Expenditure

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COMPULSORY: MONETARY CONTRIBUTION OR ASSISTANCE OFFERED TO LIVINGSTONE HIGH SCHOOL
Learner’s Surname Learner’s First Name Grade School Fees offered by parents
per month for 12 months
1
2
3
4
TOTAL R
In addition to a monetary contribution, I am prepared to assist the School in the following way
Please tick:

Providing skilled labour to  maintain buildings and/or grounds

 Other (Please specify)
DECLARATION BY PARENT(S)/GUARDIAN(S)
I/We (Full names & surname)_________________________________________________________ and

(Full names & surname) _____________________________________________________________

Hereby solemnly declare that without assistance, for which I/we am/are hereby applying, I/we will not in any
way be in a position to provide for the education of my/our child/ren, that I/we have not withheld any
information whatsoever regarding my/our circumstances and that all the information given on this application
is true complete and correct. I/we accept that if, at any stage, it is established that the information given by
me/us is not correct, financial assistance awarded to me/us will be withdrawn and the amount of such
assistance already granted will be recoverable from me/us. I/We also hereby give the School Governing Body
or anyone appointed by them, the required permissions to perform the necessary checks (including Credit and
Bank checks), enquiries and investigations in order to establish the authenticity of all information provided in
this application.

Date: _______________ Signature: ____________________________________________

Date: _______________ Signature: ____________________________________________

The declarer hereby confirms that he/she is fully conversant with the contents of this declaration and
understands it.

Sworn by me at ------- --------------------------------------- on the ----------------- day of ------------------------------20-----

Magistrate/Justice of the Peace/Commissioner of Oaths:
FOR OFFICIAL USE
Annual income of both parents R
Contribution Offered R
E. Factor Percentage:
Reduced fee level

SGB REVIEW
Accept Offer Yes No 

Apply Reduced/Min Fee Yes No 

Home Visit Required Yes  No 

Signature: ---------------------------------------------- Date Finalised: ----------------------

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