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Application Form

This document is an application form for prospective students of Liutebm University, detailing personal information, educational background, work experience, and program preferences. It outlines the registration process, associated fees, and payment terms, as well as the university's contact information. Additionally, it includes a declaration section for applicants to confirm the accuracy of their provided information.

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nyabvuretawananyasha9
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© © All Rights Reserved
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12 views

Application Form

This document is an application form for prospective students of Liutebm University, detailing personal information, educational background, work experience, and program preferences. It outlines the registration process, associated fees, and payment terms, as well as the university's contact information. Additionally, it includes a declaration section for applicants to confirm the accuracy of their provided information.

Uploaded by

nyabvuretawananyasha9
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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LIUTEBM UNIVERSITY

LIVINGSTONE INTERNATIONAL UNIVERSITY OF TOURISM EXCELLENCE AND BUSINESS


MANAGEMENT

APPLICANTS DETAILS

SURNAME:
………………………………………………………………................................

FIRST NAME:…………………………………………………………………………………...

MIDDLE/OTHER NAMES:…………………………………………………………………….

GENDER……..M-Male F-Female

TITLE:Prof/Dr/Mr./Mrs./Miss/Ms please tick:


…………............................................

DATE OF BIRTH:………………………………………………………………………………

NATIONALITY:………………………………………………………………………………..

NRC NO…………/……/…….. or PASSPORT NO (for non-Zambians)


……………………………

Physical Address:
………………………………………………………………………………….

………………………………………………………………………………………………………

Telephone:………………………………….Mobile:
……………………………………………...

Email:
………………………………………………………………………………………………

Education service with excellence


Current Qualifications:
…………………………………………………………………………...

……………………………………………………………………………………………………..

Work experience of any state:


……………………………………………………………………

………………………………………………………………………………………………………

Programme applied for:


………………………………………………………………………….

Enrolment Period: January /June /September (Please tick as


appropriate)

Session: Day /Evening /weekend /Mobile Distance learning


(Please tick as appropriate)

How did you hear about us? Newspaper /Radio/ /Website


/Referral

EMPLOYER DETAILS:

Name and address of employer:


…………………………………………………………………..

…………………………………………………………………………………………………….

Title of Post held:


………………………………………………………………………………….

How many years have held this post:


……………………………………………………………..

Do you have any physical or communication Disabilities? Yes


No

Education service with excellence


If Yes, tick where applicable Vision /Mobility /speech /hearing

If none of the above, give details of disability:


…………………………………………………..

…………………………………………………………………………………………………….

PARENTS/GUARDIAN/NEXT OF KIN’S details(Delete which is not applicable)

Names:
……………………………………………………………………………………………………………….....

Address:
………………………………………………………………………………………………………………....

Mobile:
…………………………………………………………………………………………………………………..

SPONSOR’s Details: Parents/Guardians/Company/Self:(Delete which is


not applicable)

Name:…………………………………………………………………………………………………………………

Physical address:
……………………………………………………………………………………………………..

Mobile Phone:
………………………………………………………………………………………………………..

Email Address:………………………………………………………………………………………………………

Attach: Copy of NRC, Copy of grade twelve results, 1 Passport size


photo and transcripts

UNIVERSITY TERMS AND CONDITIONS:

1. This is not an acceptance agreement with the University, but


forms part of the assessment process for University entry.
2. A non refundable registration fee of Two Hundred Kwacha
(K200) for undergraduate programmes, Three Hundred Kwacha
(K300) for post graduate programmes and Six Hundred Kwacha
(K600) for Phd respectively; should accompany the registration
form and one passport size photo, photocopy of all relevant
qualifications as well as copy of national registration card.

Education service with excellence


3. Programmes commence in January, June and September of
each year, with one week of registration and orientation.
4. The annual fees are split into two, to accommodate the two
semesters in the calendar year.
5. Fees must be paid before commencement of the course. The
University will, where necessary implement flexible payment
plans for students.
6. Payment Terms: the University allows a 50% down payment on
commencement and the balance is paid in installments-
maximum of 3, to the end of the semester.
7. Tuition fees once paid are non -refundable after one month
upon commencement of course, and a surcharge of 45% will
apply on withdrawal within one month
8. All payment are to be deposited into our account:

UNIVERSITY BANK DETAILS:

Bank Name: ACCESS BANK


Bank Branch: LUSAKA SQUARE BRANCH
Account Number: 0080100000914
Account Name: LIUTEBM UNIVERSITY
(Livingstone International University of Tourism Excellence and Business Management)

DECLARATION:

I confirm that, to the best of my knowledge, the Information given


on this form is correct. I have read the terms and conditions of the
University and agree to abide by them.

Applicants Name:………………………………………………………………………………

Education service with excellence


Signature:…………………………………….Date:
………………………………………….

LIUTEBM UNIVERSITY CONTACT DETAILS:

Plot No.2746M Ibex Hill, 2nd Street, Lusaka East

P.O. Box 38490LUSAKA, Zambia

Telephone: 0211 – 237897

Mobile: 0977 766 866/0979544912/0978 430872/0979 700090

Email: [email protected]
Website: www.liutebmuniversity.org

FOR OFFICIAL USE ONLY

Date bought…………………………………………………………………………

Received by………………………………………………………………………….

Date………………………………………………………………………………….

Processed by………………………………………………………………………...

Date………………………………………………………………………………….

Verified by…………………………………………………………………………..

Date………………………………………………………………………………….

Education service with excellence

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