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1. PERSONAL DETAILS
What type of ID?
ID Number
Alternate ID Number
National ID Number
Alternate ID
Alternative ID Type
None
Driver’s Licence
Temporary ID number
Unknown
Work Permit Number
Employee Number
Birth Certificate Number
HSRC Register Number
ETQA Record Number
Refugee Number
Membership Number SAQA
Equity
Black: African
Coloured
Indian/Asian
Other
Unknown
White
Nationality
South Africa
SADC except SA (i.e. NAM to ZAI)
Namibia
Botswana
Zimbabwe
Angola
Mozambique
Lesotho
Swaziland
Malawi
Zambia
Mauritius
Tanzania
Seychelles
Zaire
Rest of Africa
European countries
Asian countries
North American countries
Central and South American countries
Australia Oceania countries
Other and rest of Oceania
N/A: Institution
Unspecified
Home Language
English
Afrikaans
Other
South African Sign Language
sePedi/Northern Sotho / Sesotho sa Lebowa
seSotho
seTswana
siSwati
tshiVenda
Unknown
isiXhosa
xiTsonga
isiZulu
isiNdebele
Gender
Male
Female
Citizen Resident Status
Unknown
South Africa
Other
Dual (SA plus other)
Permanent Resident
Socioeconomic Status
Unspecified
Employed
Unemployed, looking for work
Not working – not looking for work
Home-maker (not working)
Scholar/student (not working)
Pensioner/retired (not working)07
Not working – disabled person
Not working – not wishing to work
Not working – Not elsewhere classified
N/A: Aged <15
N/A: Institution Statistics SA
Disability Status
None
Sight (even with glasses)
Hearing (even with a hearing aid)
Communication (talking, listening)
Physical (moving, standing, grasping)
Intellectual (difficulties in learning); retardation
Emotional (behavioural or psychological)
Multiple
Disabled but unspecified
Last Name
First Name
Middle Name
Title
Birth_Date
Home Address 1
Home Address 2
Home Address 3
Home Address Postal Code
Postal Address 1
Postal Address 2
Postal Address 3
Postal Address Post Code
Phone Number
Cell Phone Number
Fax Number
Email Address
Province
Western Cape
Eastern Cape
Northern Cape
Free State
Kwazulu Natal
North West
Gauteng
Mpumalanga
Limpopo
SA National (i.e. in SA but province unspecified)
Outside SA
Previous Last Name
Previous Alternate ID
Previous Alternative ID TYPE
Ability to See*
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties (TBC)
May have difficulty (TBC)
Former difficulty - none now
Ability to Hear*
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties (TBC)
May have difficulty (TBC)
Former difficulty - none now
Ability to Walk*
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties (TBC)
May have difficulty (TBC)
Former difficulty - none now
Ability to Communicate*
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties (TBC)
May have difficulty (TBC)
Former difficulty - none now
Ability to Remember*
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties (TBC)
May have difficulty (TBC)
Former difficulty - none now
Ability to Take Care of Self*
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
Cannot yet be determined
May be part of multiple difficulties (TBC)
May have difficulty (TBC)
Former difficulty - none now
2. CERTIFICATION
Certification Name
None
CISA
CISM
Date Certified
Certification Name
None
CISA
CISM
Date Certified
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