PERSONAL INFORMATION FORM
Please complete all items either by inserting the correct information or ticking/ circling the
relevant item. Please complete this form in BOLD letters.

PERSONAL DETAILS
Employee Number

Start Date (DD,MM,YYYY)
Surname

First Names

Date of Birth

Adv

Dr

Prof

Title

Preferred Name/ Nick
Name
Ethnic Group

Mrs

Mr

Ms

Other

Initials
African

Indian

White
Marital Status

Gender

Male

Female

Coloured
S

M

Preferred Language

D

W

Previous Surname
Home Language

CITIZENSHIP
By birth

Passport Number
Date Issued (DD/MM/YY)
Date Expiring (DD/MM/YY)

/

/

/

/

Country of Issue

SA
Citizenship

Permanent Residence /Naturalization
Other

Nationality

SA. ID Number

WORK PERMIT DETAILS
Should you hold a work permit, please complete the fields below.
Date Issued
Permit Number
(DD/MM/YYYY)
Date Expiring
(DD/MM/YYYY)

/

/

ADDRESS DETAILS
Permanent Address

Residential Address

Street Address Line 1

If No: Address Line 1

Street Address Line 2

Address Line 2

Suburb

Suburb

City

P.O. Box

Province

City

Postcode

Postcode

Telephone (H)

Cell Number

Telephone (W)

Email

Page 1

Same as permanent address
Yes
No

SARS INFORMATION
Revenue
Office

Income Tax Number

SUPPLEMENTARY INFORMATION
Spouse Birth Date
(DD/MM/YYYY)

Spouses Full Name

/

/

Spouses SA. ID Number
Yes

Do you have a Disability?
If yes, state disability
condition (EE Act
Requirement)

No

Disability Number

NEXT-OF-KIN DETAILS/ EMERGENCY CONTACT 1
Name

Relationship

Primary Contact (Note: Please mark only
one contact as primary)

Yes

No

Address & Phone
same as employee?

Residential Address:

Postal Address:

Street

Street

Suburb

Suburb

Yes

No

P.O. Box
City

City

Postcode

Postcode

Telephone (H)

Telephone (W)

Cell Number

Email

DEPENDANTS
Dependant 1
Full Name

Birth Date

SA I.D Number

Relationship
Male

Gender
Dependant 2

Female

Medically Dependant

Full Name

Birth Date

SA I.D Number

Relationship
Male

Gender
Dependant 3

Female

Medically Dependant

Full Name

Birth Date

SA I.D Number

Relationship

Gender

Male

Female

Medically Dependant

Page 2

/

Yes

No
/

Yes

/

No
/

Yes

/

/

No

Dependant 4
Full Name

Birth Date

SA I.D Number

Relationship

Gender
Dependant 5

Male

Female

Medically Dependant

Full Name

Birth Date

SA I.D Number

Relationship

Gender

Male

Female

/

/

Yes

No
/

Medically Dependant

/

Yes

No

QUALIFICATIONS: (Please start with the highest qualification)
Tertiary Education 1
Institution
Qualification Obtained
Highest Qualification

Yes

No

Date Obtained
(DD/MM/YYY)

Majors/ Specialisation

/
Graduated

/
Yes

No

Tertiary Education 2
Institution
Qualification Obtained
Highest Degree

Yes

No

Date Obtained
(DD/MM/YYY)

Majors/ Specialisation

/
Graduated

/
Yes

No

Tertiary Education 3
Institution
Qualification Obtained
Highest Degree

Yes

No

Date Obtained
(DD/MM/YYY)

Majors/ Specialisation

/
Graduated

/
Yes

No

MEMBERSHIP OF PROFESSIONAL BODIES
Membership of Professional Bodies 1
Society Name

Post Held (if any)

Type of membership

Date Joined
(DD/MM/YYYY)(

/

/

/

/

Membership of Professional Bodies 2
Society Name

Post Held (if any)

Type of membership

Date Joined
(DD/MM/YYYY)

By affixing my signature below, I confirm that the information provided is true to the
best of my knowledge.

Signature _________________________________Date _____________________

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