V01/17/ZA

Regenesys Management Tel : +27 (0)11 669 5000

4 Pybus Road, Fax : +27 (0)11 669 5001
(cnr. Katherine & Pybus) Email : info@regenesys.co.za
Sandton, South Africa Web : www.regenesys.net

WAITING LIST APPLICATION FORM

DOCTORATE IN BUSINESS MANAGEMENT

For office use Student number Referral code

Personal Information

ID number Mandatory field, ID or Passport Number required. Cannot be left blank.

Title Surname
First name Gender M F (Tick applicable box)

Middle name(s)
Citizenship Nationality
Home language Highest academic qualification
First name Date of birth D D M M Y Y Y Y
Cell Tel International dialling code +
E-mail
Residential Postal
address address

Province Province
Country
Code Code

Sponsor Details

Company
Name
Job title
Department Industry
Tel International dialling code + Years’ work experience
E-mail

WAITING LIST REQUIREMENTS

Please tick and ensure that you submit the following, as part of your DBM waiting list application

An application form

A certified copy of highest qualification (Masters level degree)

A Statement of Research Intent

A CV including the relevant work experience

A motivation letter for inclusion into the programme

Proof of payment of the R1,000 application fee

Bank Account Details

Regenesys Management

1. Standard Bank, Killarney Branch 2. ABSA, Sandton Business Banking 3. Investec Bank
Account Number: 001663127, Cheque Account Account Number: 40 - 9038 - 9951, Account Number: 10011220086,
Branch Code: 007205 Cheque Account Cheque Account
Branch Code: 632005 Branch Code: 580105
Reference: Student number/ID number
Send proof of payment to payments@regenesys.co.za and to the student advisor
Regenesys Management (Pty) Ltd. is registered with the Department of Education as a private higher education institution under the Higher Education Act, 1997. Registration Certificate No. 2000/HE07/02

1
Initial page here (applicant): Initial page here (sponsor):
 V01/17/ZA

Regenesys Management Tel : +27 (0)11 669 5000

4 Pybus Road, Fax : +27 (0)11 669 5001
(cnr. Katherine & Pybus) Email : info@regenesys.co.za
Sandton, South Africa Web : www.regenesys.net

INITIAL STATEMENT OF RESEARCH INTENT

You can also attach a Word or PDF document.

Provisional title of thesis or area of research interest, and a brief description of the proposed research

Briefly summarise any previous research/ professional experience in your area of interest

Regenesys Management (Pty) Ltd. is registered with the Department of Education as a private higher education institution under the Higher Education Act, 1997. Registration Certificate No. 2000/HE07/02

1
Initial page here (applicant): Initial page here (sponsor):