University Of Cape Town Dp Certificate Form Page 2

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PLEASE ENSURE THAT ALL THE INFORMATION ON THIS SECTION IS COMPLETED
SURNAME: …………………… NAME: ……………………………… INITIALS: ……… TITLE: ..............
STUDENT NUMBER: ………………………………
FACULTY: …………………………………………...
EMAIL ADDRESS: We shall send an email to both your private email address (if you provide one) and to
your UCT email address. Please check both as we shall not be held responsible if the email to your private
email address comes back as “undeliverable”. If the student has not RECEIVED any correspondence via
EMAIL from the Deferred Examination Committee
WITHIN 7 DAYS
of submitting the application, please
contact the Deferred Examination Committee as it might be that more information is required for your
application to be finalised.
PLEASE WRITE CLEARLY:
Email address: ……………………………………….…………………………………………………………….
Tel number: …………………………………
Cell number: ………………………..………..
List ALL the examinations you were registered to write during the examination period and mark those you
are asking for deferment for with "YES" in the space provided. Indicate whether you have a "DP" and if
the examination(s) has been WRITTEN or ATTEMPTED. Please note any information that is incorrectly
listed here will not be grounds for appealing the decision of the Deferred Examination Committee.
Have you written
Does the
Tick if DP
Requesting
Course Code
Paper/
Exam
Exam
or attempted to
course have
form is
Deferment
Module
Time
Date
write the exam
a DP
completed
(DE)
(Eg ELL1001W)
Number
YES/NO
YES/NO
and
YES/NO
attached
Have you been granted deferred examinations in any courses in this year or previous years? YES/NO
If you circled YES, please list years and courses:
………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………….
2

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