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BCE Development Programme - Student Agreement 2021.pdf
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BCE STUDENT AGREEMENT 20190215.pdf
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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml"> <head> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <title>Untitled Document</title> <style type="text/css"> .standardstyle { font-size: 12px; font-family: Verdana, Geneva, sans-serif; line-height: 18px } .standardmainheading { font-size: 18px; font-family: Verdana, Geneva, sans-serif; line-height: 20px; color: #E36C0A } .standardheading { font-size: 14px; font-family: Verdana, Geneva, sans-serif; line-height: 18px; color: #E36C0A } </style> <style type="text/css"> <!-- p.MsoNormal { margin-top:0cm; margin-right:0cm; margin-bottom:10.0pt; margin-left:0cm; line-height:115%; font-size:11.0pt; font-family:"Calibri","sans-serif"; } table.MsoTableGrid { border:solid windowtext 1.0pt; font-size:11.0pt; font-family:"Calibri","sans-serif"; } --> </style> <style type="text/css"> <!-- p.MsoListParagraph { margin-top:0cm; margin-right:0cm; margin-bottom:10.0pt; margin-left:36.0pt; line-height:115%; font-size:11.0pt; font-family:"Calibri","sans-serif"; } --> </style> <style type="text/css"> <!-- p.MsoListParagraphCxSpMiddle { margin-top:0cm; margin-right:0cm; margin-bottom:.0001pt; margin-left:36.0pt; line-height:115%; font-size:11.0pt; font-family:"Calibri","sans-serif"; } --> </style> <style type="text/css"> <!-- span.msoIns { text-decoration:underline; text-underline:single; color:teal; } p.MsoListParagraphCxSpLast { margin-top:0cm; margin-right:0cm; margin-bottom:10.0pt; margin-left:36.0pt; line-height:115%; font-size:11.0pt; font-family:"Calibri","sans-serif"; } span.msoDel { text-decoration:line-through; color:red; } --> </style> </head> <body> <table width="955" border="0" align="center" cellpadding="0" cellspacing="0" class="standardstyle"> <tr> <td><p><b><span class="standardmainheading">Cooperative Agreement</span></b></p> <p><span style='font-size:10.0pt;; color:black'>This Cooperative Agreement binds the Student, his/her Employer and CESA in a relationship for the duration that the Student takes to complete the full programme. </span></p> <p style='margin-bottom:0mm;margin-bottom:.0001pt;text-align: justify'><span style='font-size:10.0pt;line-height: 115%;font-family:"Arial","sans-serif";color:black'>The aim of the Agreement is to fundamentally clarify the rights, the roles and responsibilities of each of the parties to the Agreement being the Student, the Employer and CESA, and the resources required.</span></p> <p style='margin-bottom:0mm;margin-bottom:.0001pt;text-align: justify'><strong><span style="color:black; ">INTERPRETATIONS AND DEFINITIONS</span></strong><br /> </p> <table border="0" cellspacing="0" cellpadding="2" width="80%" style="border-collapse:collapse;border:none;"> <tr> <td width="38%" valign="top" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="line-height:115%; font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Assignment</span></p></td> <td width="62%" valign="top" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><span style="color:black; ">A task/activity given to a Student </span><span style="color:black; ">in accordance with required outcomes, to be completed within a specific time and submitted via the CESAnet.</span></p></td> </tr> <tr> <td width="38%" valign="top" bgcolor="#E2E2E2" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">BCE</span></p></td> <td width="62%" valign="top" bgcolor="#E2E2E2" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Business of Consulting Engineering.</span></p></td> </tr> <tr> <td width="38%" valign="top" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">CESA</span></p></td> <td width="62%" valign="top" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Consulting Engineers South Africa.</span></p></td> </tr> <tr> <td width="38%" valign="top" bgcolor="#E2E2E2" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">CESAnet</span></p></td> <td width="62%" valign="top" bgcolor="#E2E2E2" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;">A Student and Facilitators’ Intranet whereby both parties will be able to access the training material, assignments, activities, reference and resource documents (Electronic Library), and Students will be able to upload their assignments, get their results, email facilitator/s and other class Students.</p></td> </tr> <tr> <td width="38%" valign="top" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Contact Sessions</span></p></td> <td width="62%" valign="top" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="text-align:justify;line-height:115%;"><span style="line-height:115%; font-family:'Calibri','sans-serif'; font-size:11.0pt; ">Three separate block weeks, of 5 working days each (Monday - Friday)</span> <span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; ">comprising full-day lectures and possible evening lectures.</span> </p></td> </tr> <tr> <td width="38%" valign="top" bgcolor="#E2E2E2" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Development Programme</span></p></td> <td width="62%" valign="top" bgcolor="#E2E2E2" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Business of Consulting Engineering Development Programme</span></p></td> </tr> <tr> <td width="38%" valign="top" ><p style="text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Due date</span></p></td> <td width="62%" valign="top" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">The date by which the Fee shall be paid but which will not be later than two weeks prior to the commencement of the BCE Development Programme.</span></p></td> </tr> <tr> <td width="38%" valign="top" bgcolor="#E2E2E2" ><p style="text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Duration of Development Programme</span></p></td> <td width="62%" valign="top" bgcolor="#E2E2E2" ><p class="MsoNormal" style="margin-top:0cm;margin-right:0cm;margin-bottom:.0001pt;margin-left:1.7pt;text-align:justify;line-height:115%;"><span style="color:black; ">A minimum of one year and a maximum three years.</span></p></td> </tr> <tr> <td width="38%" valign="top" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Employer</span></p></td> <td width="62%" valign="top" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="margin-left:1.7pt;text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">The company which has enrolled the Student onto the development programme.</span></p></td> </tr> <tr> <td width="38%" valign="top" bgcolor="#E2E2E2" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Facilitator</span></p></td> <td width="62%" valign="top" bgcolor="#E2E2E2" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Each student is allocated a dedicated Facilitator, who supports the student throughout the programme.</span></p></td> </tr> <tr> <td width="38%" valign="top" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Fee</span></p></td> <td width="62%" valign="top" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">The price paid by the Employer/the Student to CESA for a single Student to attend the BCE Development Programme offered by CESA, which covers inter alia attendance at the three (3) block weeks, refreshments and lunch, writing and marking of exams and assignments, ECSA CPD points and certificate, assessing and moderating, the use of the CESAnet, but excludes accommodation and travel expenses, stationery, computer equipment and all other personal expenses. </span></p></td> </tr> <tr> <td width="38%" valign="top" bgcolor="#E2E2E2" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Parties</span></p></td> <td width="62%" valign="top" bgcolor="#E2E2E2" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">The signatories to this Agreement.</span></p></td> </tr> <tr> <td width="38%" valign="top" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Portfolio of Evidence</span></p></td> <td width="62%" valign="top" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">The Portfolio of Evidence consists of successfully completed assignments, activities, workplace observation reports and mentor reports.</span></p></td> </tr> <tr> <td width="38%" valign="top" bgcolor="#E2E2E2" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">SCE</span></p></td> <td width="62%" valign="top" bgcolor="#E2E2E2" style="width:291.55pt;padding:0cm 5.4pt 0cm 5.4pt;"><p style="margin-left:1.7pt;text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">School of Consulting Engineering.</span></p></td> </tr> <tr> <td width="38%" valign="top" ><p style="margin-left:75.8pt;text-align:justify;text-indent:-75.8pt;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">Student</span></p></td> <td width="62%" valign="top" ><p style="margin-left:1.7pt;text-align:justify;line-height:115%;"><span style="font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; ">The employee of the Employer, attending the development programme.</span></p></td> </tr> </table> <p style='line-height:normal'><b><span class="standardheading"> 1. STUDENT</span></b></p> <p class=MsoListParagraphCxSpFirst style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:35.7pt;margin-bottom:.0001pt;text-align:justify; text-indent:-17.85pt'><b><span style='font-size:10.0pt;; color:black'>1.1.</span></b><b><span>The rights of the <span style='color:black'>Student are to:</span></b><br /> <br /> </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:65.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-29.5pt'><span >1.1.1.<span> </span></span><span >Be trained in terms of this agreement</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:65.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-29.5pt'><span >1.1.2.<span> </span></span><span>Have access to the required resources</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:65.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-29.5pt'><span >1.1.3.<span> </span></span><span>Receive training in terms of the programme </span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:65.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-29.5pt'><span >1.1.4.<span> </span></span><span>Have his/her performance assessed and have access to the assessment results</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:65.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-29.5pt'><span >1.1.5.<span> </span></span><span>Receive a certificate upon the successful completion of the develop programme</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:65.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-29.5pt'><span >1.1.6.<span> </span></span><span>Raise grievances in writing with CESA's Education and Training Committee concerning any short comings in the training </span><br /> <br /> </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:35.7pt;margin-bottom:.0001pt;text-align:justify; text-indent:-17.85pt'><b><span style='font-size:10.0pt;; color:black'>1.2.<span> </span></span></b><b><span>The roles and the responsibilities of the <span style='color:black'>Student are to:</span></span></b><br /> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:65.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-29.5pt'><span >1.2.1. </span><span >Tke full responsibility for his/her own learning</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.2.<span> </span></span><span >Participate actively in the scheduled contact sessions</span><span > and ensure full participation in </span><span >discussions and interact as required</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.3. </span><span >Undertake extensive reading (including pre and post contact session reading)</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.4. </span><span >Perform research and self assessment</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.5. </span><span >Attend contact sessions ( 3 x block weeks)</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.6.<span> </span></span><span >Complete the full development programme within a minimum period of one year and a maximum of three years.</span></p> <p class=MsoListParagraph style='margin-top:0mm;margin-right:0mm;margin-bottom: 0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify;text-indent: -35.45pt'><span >1.2.7.<span> </span></span><span >Respect the programme timetable by arriving at contact sessions and submitting assignments on time, and in accordance with the instructions</span></p> <p class=MsoListParagraph style='margin-top:0mm;margin-right:0mm;margin-bottom: 0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify;text-indent: -35.45pt'><span >1.2.8. </span> <span >Comply with the learning programme code of conduct</span></p> <p class=MsoListParagraph style='margin-top:0mm;margin-right:0mm;margin-bottom: 0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify;text-indent: -35.45pt'><span >1.2.9.<span> </span></span><span >Completing assignments on time within specified levels of quality and in accordance with the instructions and required outcomes</span></p> <p class=MsoListParagraph style='margin-top:0mm;margin-right:0mm;margin-bottom: 0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify;text-indent: -35.45pt'><span >1.2.10.<span> </span></span><span >In the case where a Student pays</span><span > for his own registration fee and all other expenses related to attending and participating in the programme, the Student is responsible in terms of the payment clause.</span></p> <p class=MsoListParagraph style='margin-top:0mm;margin-right:0mm;margin-bottom: 0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify;text-indent: -35.45pt'><span >1.2.11.<span> </span></span><span >Ensure the Employer's confidential information is protected and not given out to any unauthorised individuals </span></p> <p class=MsoListParagraph style='margin-top:0mm;margin-right:0mm;margin-bottom: 0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify;text-indent: -35.45pt'><span >1.2.12.<span> </span></span><span>Diligently prepare, study for and attend final examinations </span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.13. </span><span >Work for the Employer as part of the learning process</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.14. </span><span >Have a good mastery of the English language. Contact sessions, presentation, training material, hand-out and assignments will be conducted and completed in English. </span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.15. </span><span >Observe all health and safety requirements while at contact session's premises. </span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.16. </span><span >Inform CESA of any personal factors and health concerns (including mental health) or disabilities.</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.17. </span><span>Access and utilise the CESAnet for the training material, assignments, activities, reference and resource documents (Electronic Library), upload his/her assignments, get his/her results, email facilitator/s and other class Students. </span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.18. </span><span >Comply with workplace policies and procedures</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.19. </span><span>Complete any timesheets or any written assessment tools supplied or required by the Employer to record relevant workplace experience</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.20.<span style='font:7.0pt "Times New Roman"; font-family: "Times New Roman"; font-size: 7.0pt'> </span></span><span> Compile and complete a Portfolio of Evidence consisting of successfully completed assignments, activities, workplace observation reports and mentor reports.</span> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>1.2.21. </span><span> Maintain regular liaison with the Mentor to allow the Mentor to carry out his/her roles and responsibilities.</span><span style="margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:69.2pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt"><span style='font-size:10.0pt;; color:black'><br /> </span></span></p> <p ><b><span class="standardheading">2. MENTOR</span></b></p> <p class="MsoListParagraph" style="margin-top:0cm;margin-right:0cm;margin-bottom:.0001pt;margin-left:17.85pt;text-align:justify;">Although, we encourage students to work on their own without assistance, there are some students that require more support than others. The Workplace Mentors have a very important role to play in the overall success of their student and the programme at large.</p> <p class="MsoListParagraph" style="margin-top:0cm;margin-right:0cm;margin-bottom:.0001pt;margin-left:17.85pt;text-align:justify;"> </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:35.7pt;margin-bottom:.0001pt;text-align:justify; text-indent:-17.85pt'><b><span>2.1.<span> </span></span></b><b><span>The rights of the <span style='color:black'>Mentor are to</span></span></b><span style='font-size: 10.0pt;;color:black'>:</span><br /> <br /> </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span>2.1.1.<span> </span></span><span style="color:black; ">To be treated with respect.</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color:black; ">2.1.2. To set your mentoring schedule to fit with your work and personal needs.</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color:black; ">2.1.3. To receive sufficient training, support, and resources to do your job well.</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color: black">2.1.4. </span>Receive feedback reports on the Student's performance and results, whilst on the development programme. </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>2.1.5. <span style="color:black; ">You are not expected to do the Student's assignments and/or activities. </span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color:black; ">2.1.6. You have the right to refuse to do any work that is unethical or inappropriate.</span><br /> <br /> </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:35.7pt;margin-bottom:.0001pt;text-align:justify; text-indent:-17.85pt'><b><span style='font-size:10.0pt;; color:black'>2.2.<span> </span></span></b><b><span>The roles and the responsibilities of the <span style='color:black'>Mentor are to:</span></span></b><br /> <br /> </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>2.2.1.<span> </span></span>To play an active part in their students' progress on the programme </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>2.2.2. Provide support to their student in the workplace</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>2.2.3. Assist with providing their student with information for their assignments, or referring the student to other expertise in the workplace that can assist.</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>2.2.4. Liaise with the student's facilitator on their student's progress and any other concerns they might have with regards to the programme and their student.</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>2.2.5. Deal with workplace issues that may affect their student's progress on the programme</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>2.2.6. Allowing and/or arranging access to company information for research and assignment purposes. (This information will be kept confidential at all times)</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>2.2.7. Making time available for the student to discuss assignment questions and to be enriched by the mentors knowledge and experience.</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>2.2.8. Assistance with ensuring that assignments are submitted timorously</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>2.2.9. Encourage and promote that the students combines their formal learning from the classroom and submission of assignments with the reality of actual workplace experiences. </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'> </p> <p class="MsoNormal">Assist their students to complete or enhance, if necessary, their Activities (Workbooks), which will need to be handed in, with their ‘Portfolio of Evidence’ at the end of the programme.</p> <p ><b><span class="standardheading">3. EMPLOYER</span></b></p> <p style='margin-left:35.7pt;text-align:justify; text-indent:-17.85pt'><b><span style='font-size:10.0pt;; color:black'>3.1.<span style='font:7.0pt "Times New Roman"'> </span></span></b><b><span>The rights of<span style='color:black'> the Employer are to:</span></span></b></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>3.1.1.<span style='font:7.0pt "Times New Roman"'> </span></span>Expect the other Parties to fulfill their obligations in terms of this agreement </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>3.1.2. Receive feedback reports on the Student's performance and results, whilst on the development programme. </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>3.1.3. To be assured that, as humanly possible, all Employers' sensitive information will be kept confidential.<br /> </p> <p style='margin-left:35.7pt;text-align:justify; text-indent:-17.85pt'><b><span>3.2. The roles and the responsibilities of the Employer are to:</span></b></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>3.2.1.<span style='font:7.0pt "Times New Roman"'> </span></span><span style="color:black; ">Provide the Student with a dedicated Mentor in the work place.</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color:black; ">3.2.2. Allow Student access to Employer-information for research and assignment purposes. This information will be kept confidential at all times.</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color:black; ">3.2.3. Release the Student during normal working hours to attend contact sessions (3 block weeks, comprising 5 working days each)</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color: black">3.2.4. </span>Comply with the <span style="color:black; ">Basic Conditions of Employment Act (No. 75 of 1997)</span> in terms of required duties and all other applicable legislation including:</p> <ul> <ul> <li><span style="color:black; ">Any applicable determination made in terms of Section 18(3) of the Act </span></li> <li><span style="color:black; ">Labour Relations Act (No. 66 of 1995) </span></li> <li><span style="color:black; ">Employment Equity Act (No. 55 of 1998) </span></li> <li><span style="color:black; ">Occupational Health and Safety Act (No. 85 of 1993) or Mine Health and Safety Act (No. 27 0f 1996) </span></li> <li><span style="color:black; ">Compensation </span>for Occupational Injuries and Diseases Act (No. 130 of 1993)<span style="color:black; "> </span></li> </ul> </ul> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color:black; ">3.2.5. Pay registration fee and all other expenses related to attending and participating in the programme in terms of the payment clause.</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color:black; ">3.2.6. Provide the Student with access to a computer (preferably a laptop) and internet for research and assignments</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color: black">3.2.7. </span>Provide the Student with appropriate training in the work environment to achieve the relevant outcome required by the programme</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color: black">3.2.8. </span>Arrange and/or conduct a quick online on-the-job assessment of the Student progress at the work place, on a trimester basis and submit it electronically to CESA </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>3.2.9. The Employer is advised to conclude a separate contract with the Student/ Employee to govern the Student’s obligation to the Employer with regard to the BCE Development Programme</p> <p ><b><span class="standardheading">4. CESA</span></b></p> <p style='margin-left:35.7pt;text-align:justify; text-indent:-17.85pt'><b><span style='font-size:10.0pt;; color:black'>4.1. </span><span>The rights of<span style='color:black'> CESA are to:</span></span></b></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>4.1.1.<span> </span>Access the Student's books/files, learning material and if necessary to visit him/her in workplace.</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>4.1.2.<span> </span>Share and/or include in its programmes exceptional assignments submitted by Students and/or certain information that would be constructive to the improvement and/or the further development of the programmes in the opinion of CESA. In exercising the right, CESA undertakes to consult with the Employer and Student regarding the removal/omission of sensitive details/material. </span></p> <p style='margin-left:35.7pt;text-align:justify; text-indent:-17.85pt'><b><span>4.2. The roles and the responsibilities of CESA are to:</span></b></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>4.2.1.<span> </span></span><span >Provide education and training in terms of the Programme</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>4.2.2.<span> </span></span><span >Provide Convenors, Facilitators and Subject Experts in the relevant modules</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>4.2.3.<span> </span></span><span >Where necessary provide training material and resources </span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>4.2.4.<span> </span></span><span >Allocate a Facilitator to each Student, to provide support and guidance</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>4.2.5.<span> </span></span><span >Record, monitor and retain Student's contact details, together with related information with regard to the programme, such as CV, qualifications and results etc.</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>4.2.6.<span> </span></span><span >Provide ongoing assessment of the Students performance for the duration of the programme and send reports to the Employer, on the Student's performance</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>4.2.7.<span> </span></span><span >Provide the opportunity for the Student to give feedback to CESA on any problems/concerns they have uncounted</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>4.2.8.<span> </span></span><span>Ensures that as humanly possible, all Employers' confidential and sensitive information will be kept confidential. </span></p> <p ><b><span class="standardheading">5. FACILITATOR</span></b></p> <p style='margin-left:35.7pt;text-align:justify; text-indent:-17.85pt'><b><span style='font-size:10.0pt;; color:black'>5.1. </span><span>The rights of<span style='color:black'> the FACILITATOR are to:</span></span></b></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>5.1.1.<span style='font:7.0pt "Times New Roman"'> </span></span>To be treated with respect.</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>5.1.2. <span style="color:black; ">Access the Student's books/files, learning material and if necessary to visit him/her in workplace.</span></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style="color: black">5.1.3. </span>Expect the other Parties to fulfill their obligations in terms of this agreement, in order for them to help the students perform their assignments and activities </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>5.1.5. Receive feedback reports on the Student's performance and results, whilst on the development programme.</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>5.1.6. You are not expected to do the Student's assignments and/or activities. </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>5.1.7. You have the right to refuse to do any work that is unethical or inappropriate. </p> <p style='margin-left:35.7pt;text-align:justify; text-indent:-17.85pt'><b><span>5.2. The roles and the responsibilities of the FACILITATOR are to:</span></b></p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'><span style='font-size:10.0pt;; color:black'>5.2.1.<span style='font:7.0pt "Times New Roman"'> </span></span>Facilitators are to establish contact with the student's Workplace Mentors, at the beginning of the programme and carry out and highlight the following:</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'> </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-15.45pt'>5.2.1.1. Introduce themselves and give their contact details to the Mentor and encourage interaction</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-15.45pt'>5.2.1.2. Inform the Mentor that they are the student's facilitator, whose basic role is to interact with the student throughout the programme and to provide support, guidance and feedback on any matters</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-15.45pt'>5.2.1.3. Explain the journey the student will be undertaking </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-15.45pt'>5.2.1.4. Briefly give the Workplace Mentor some ideas or suggestions on how they can support and assist the students throughout the programme.</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-15.45pt'> </p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>5.2.2. On a regular basis, throughout the programme, the facilitator will contact the Mentor, either by phone or email, and give them progress reports on their student and the programme.</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>5.2.3. Obtain feedback from the Mentor, on how the student is progressing in the workplace and if there has been any noticeable changes with his/her performance.</p> <p style='margin-top:0mm;margin-right:0mm; margin-bottom:0mm;margin-left:70.9pt;margin-bottom:.0001pt;text-align:justify; text-indent:-35.45pt'>5.2.4. Should any serious problems arise with the student, the facilitator will contact the Mentor to intervene and assist where necessary.</p> <p class="standardheading"><strong>6. TERMINATION OF AGREEMENT</b></strong></p> <p style='text-align:justify;text-indent:17.85pt'><span>This programme agreement terminates for individual Students when:</span></p> <p style='text-align:justify;text-indent:17.85pt'><span style="font-size: 10.0pt">6.1. </span>The Student successfully completes the Programme</p> <p style='text-align:justify;text-indent:17.85pt'>6.2. The Student is fairly dismissed by the Employer for a reason related to the Student’s conduct or capacity as an employee</p> <p style='text-align:justify;text-indent:17.85pt'>6.3. The Employer and Student agree to terminate the agreement</p> <p style='text-align:justify;text-indent:17.85pt'>6.4. The Student has terminated his/her employment with the Employer</p> <p style='text-align:justify;text-indent:17.85pt'>6.5. For good cause CESA has terminated the Agreement in consultation with the other parties.</p> <p style='text-align:justify;text-indent:17.85pt'>6.6. All intention to terminate the Agreement for individual Students shall be in writing and at the discretion of CESA</p> <p class="standardheading"><strong>7. SUBSTITUTION</strong></p> <p style='text-align:justify;text-indent:17.85pt'><span style="font-size: 10.0pt">7.1. </span>Unfortunately, due to the nature and the design of the programme, substitution is not allowed once the programme has started.</p> <p class="standardheading"><strong>8. PAYMENT</strong></p> <p style='text-align:justify;text-indent:17.85pt'><span style="font-size: 10.0pt">8.1. </span><span style="color:black; ">Payment of the fee in full will be required in advance from the Employer or Student if paying his own fee. Payment is due no later than two weeks prior to the commencement of the first contact session of the development programme.</span></p> <p style='text-align:justify;text-indent:17.85pt'><span style="color:black; ">8.2. In the event of the termination by the Employer or the student of an individual Student’s enrolment in the programme, for whatever reason, a pro-rata amount in proportion to the time remaining to complete the programme will be refunded, less a 15% administration charge. </span></p> <p style='text-align:justify;text-indent:17.85pt'><span style="color:black; ">8.3. In the event of CESA terminating an individual Student’s enrolment in the programme, a pro-rata amount will be refunded to the Employer, in proportion to the time remaining to complete the programme, viz. if 90% of the programme has been completed, a 10% refund will apply.</span><strong><span style="color:black; "> </span></strong></p> <p class="standardheading"><strong>9. DISPUTES</strong></p> <p class="MsoListParagraph" style="margin-left:17.85pt;text-align:justify;text-autospace:none;">In the event of a dispute arising, it shall be brought before CESA Education and Training Committee who will have the final decision.</p> <p class="standardheading"><strong>10. NON VARIATION</strong></p> <p style='text-align:justify;text-indent:17.85pt'>This Agreement records the entire transaction between the parties hereto and there shall be no variation unless same is submitted in writing and signed by both parties.</p> <p ><strong><span style="color:black; "><span class="standardheading"><strong>11. DECLARATION OF PARTIES</strong></span> </span></strong></p> <ul> <li><span style="color:black; ">We understand that the Agreement is mutually binding</span></li> <li><span style="color:black; ">We agree to rights, roles and responsibilities in the Agreement</span><strong><span style="line-height:115%; font-family:'Calibri','sans-serif'; font-size:11.0pt; color:black; "><span class="msoIns"><ins cite="mailto:Judy%20Barker" datetime="2013-02-19T08:51"><br clear="all" style="page-break-before:always;" /> </ins></span></span></strong></li> </ul> <p ><strong><span style="color:black; "><span class="standardheading"><strong>11. SIGNATORIES</strong></span></span></strong></p> <table class="MsoTableGrid" border="1" cellspacing="0" cellpadding="0" width="558" style="width:418.15pt;margin-left:26.7pt;border-collapse:collapse;border:none;"> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Student:</strong></p></td> <td width="246" valign="top" style="width:184.3pt;border:solid windowtext 1.0pt;border-left:none;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Designation / Name / Surname </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border:solid windowtext 1.0pt;border-left:none;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong><span style="color:black; ">Job Title</span></strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Signature</strong><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Date</strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Place </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Witness</strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Employer:</strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Designation / Name / Surname </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong><span style="color:black; ">Job Title</span></strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Signature</strong><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Date</strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Place </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Witness</strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Mentor:</strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Designation / Name / Surname </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong><span style="color:black; ">Job Title</span></strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Signature</strong><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Date</strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Place </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Witness</strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Facilitator:</strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Designation / Name / Surname </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong><span style="color:black; ">Job Title</span></strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Signature</strong><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Date</strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Place </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Witness</strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Cesa:</strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Designation / Name / Surname </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong><span style="color:black; ">Job Title</span></strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Signature</strong><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong>Date</strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:115%;"> </p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Place </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong>Witness</strong></p></td> </tr> <tr> <td width="85" valign="top" style="width:63.75pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="246" valign="top" style="width:184.3pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"><strong> </strong></p></td> <td width="227" valign="top" style="width:6.0cm;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 5.4pt 0cm 5.4pt;"><p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;line-height:normal;"> </p></td> </tr> </table> <p class="MsoNormal" style="margin-bottom:.0001pt;text-align:justify;"> </p> <p style='text-align:justify;text-indent:17.85pt'> </p></td> </tr> </table> <p> </p> </body> </html>
