REGISTRATION FORM

Student Photo

Student No:

Applicant Details

Name: Middle Name: Last Name:

ID Number: Date of Birth: Nationality:

Title: Mr Mrs Ms Dr Other Gender: Male Female Marital Status:

Contact Details

Phone Number: Alternative Phone Number:

Address:

Personal Email: Employer:

Next of Kin

Preferred Mode of Contact (Please Tick): Home/Work Phone Mobile Email

Name: Relationship: Phone Number:

Educational Background

Last School Attended:

Subjects Passed	Grades	Year

Course Applied For

I knew RIME through: Facebook LinkedIn Website Student Advisor Other

Method of Payment

Cash Debit Order Visa Card Transfer

Debit Order Details

AMT in Figures $:

Months:

Monthly Instalments:

AMT in Words:

Account Name:

Account Number:

USD:

ZWL:

Bank: Branch:

I, , do hereby apply for the above mentioned course with the Royal Institute of Management & Engineering (RIME). I acknowledge that I have received study materials on credit from RIME and I am indebted accordingly. I certify that the information I have submitted is correct and I have not withheld or concealed anything affecting the proposed application. I agree that should this application be accepted, the contract between me and RIME be strictly governed by the terms and conditions as amended from time to time by RIME. I authorise deductions from my salary or bank account due in respect of myself only. I the undersigned, authorise RIME to arrange with my employer/bank to set up the facility for fees payments on its debit order system as may be required. I understand that all fees paid prior to the date of cancellation are non-refundable (exclusive of manifest errors). This request is to remain in force until cancelled by me on RIME prescribed cancellation. I understand that deductions will only cease after the deduction scheduled for the following month from the cancellation. I also understand that the institute reserves the right to deduct fees for provided service that is still owed (such as but not limited to books, study packs and written examinations for a level). I further give authority to RIME to convert the amount to be debited in compliance with monetary policy or laws of the country as and when necessary.

Applicant / Guarantor

Name:

Signature:

Date: