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Zaqa consent Alice

This document is an Application Consent Form for the validation and evaluation of qualifications by the Zambia Qualifications Authority. It includes personal details of the qualification holder, Alice Chitundu Lukwesa, and her consent for the disclosure of educational information. The form also allows for a third party, Judy Lukwesa, to receive the results directly.

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alicekaputo
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213 views2 pages

Zaqa consent Alice

This document is an Application Consent Form for the validation and evaluation of qualifications by the Zambia Qualifications Authority. It includes personal details of the qualification holder, Alice Chitundu Lukwesa, and her consent for the disclosure of educational information. The form also allows for a third party, Judy Lukwesa, to receive the results directly.

Uploaded by

alicekaputo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Doc. ID: FORM II Effective Date: August 2016 Version No.

001

3rd Floor| Finsbury Park| Kabwe Roundabout| P O Box 51103|


LUSAKA
Tel: +260 211 843 050/3; Email: [email protected]
Website: www.zaqa.gov.zm

APPLICATION CONSENT FORM FOR

VALIDATION AND EVALUATION OF QUALIFICATIONS

Note: This form shall also save as consent for disclosure of information for the purpose of
verification and evaluation by the Zambia Qualifications Authority.

Print clearly in black or blue ink (or type)

1. Name of Qualification Holder Alice Chitundu


Lukwesa___________________________________________

2. Contact details of the applicant.


Name of applicant _________Alice Chitundu
Lukwesa________________________________________________
NRC No/Passport No
_______214315/32/1_______________________________________________
Postal address
__________Nil__________________________________________________
E-mail
[email protected]______________________________________________________
________
Tel ____________________________ Mobile
+260977756827_________________________________

3. Contact details of a third party, if a copy of the results should be forwarded to the third
party directly (note the additional fee)
Name__Judy
Lukwesa_________________________________________________________________

Page 1 of 2
Doc. ID: FORM II Effective Date: August 2016 Version No. 001

Postal address ______Indo-


Zambia_Bank_____________________________________________________
E-mail [email protected]_______________________________ Mobile
_+260979416066__________________________

I hereby consent to the disclosure of my educational information to the Zambia


Qualifications Authority.

Signature. Alice_______________________ Date: __21-03-


2025___________________________

Page 2 of 2

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