LEARNERSHIP AGREEMENT TERMINATION REPORT

L / G / A

For Official Use Only:

Date Received by INSETA / Learnerships Division Evaluation
Date:
Name:
Signature:
Designation:

Please note: A notification of termination of a Learnership Agreement must be submitted to the INSETA by the employer within 14 (fourteen) days of the learner’s termination; on this Termination Report template; stating out the reasons for the termination and signed by the employer. Where the learner is not available to sign, the employer must indicate this where the learner is supposed to sign. Under no circumstances should the employer sign for the learner.

Section A

LEARNER AND LEARNERSHIP INFORMATION

Title of Learnership and Level:

Learnership DHET Registration Code:

Learnership Start Date:

Learnership Proposed End Date:

Actual Date of Termination:

Name of Learner:

Learner’s ID Number:

Contact Number:

Name of Lead Employer:

Name of Learnership Co-ordinator:

Contact Number:

Email address:

Name of Lead Training Provider:

Name of Learnership Co-ordinator:

Contact Number:

Email address:

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Learnership Agreement Termination Report

Section B

UNIT STANDARD ACHIEVEMENT DETAILS (per Learner)

List of the Unit Standards Achieved as at date of termination:

FUNDAMENTAL UNIT STANDARDS

Unit Standard Title / Credit Value / SAQA Code / Delivery and Assessment of Unit Standards (Mark with a X) / Assessment tool and Memorandum attach as an annexure / Name of Assessor and ID number / Learner % Achieved / Learner competent (Y/N)
Theory / On-Job / Both

CORE UNIT STANDARDS

Unit Standard Title / Credit Value / SAQA Code / Delivery and Assessment of Unit Standards (Mark with a X) / Assessment tool attach as an annexure / Name of Assessor and ID number / Learner % Achieved / Learner competent (Y/N)
Theory / On-Job / Both

ELECTIVE UNIT STANDARDS

Unit Standard Title / Credit Value / SAQA Code / Delivery and Assessment of Unit Standards (Mark with a X) / Assessment tool attach as an annexure / Name of Assessor and ID number / Learner % Achieved / Learner competent (Y/N)
Theory / On-Job / Both

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Learnership Agreement Termination Report

Section C

SIGN OFF (Learner/ Employer/ Training Provider)

Reason for termination:

Learner Agreement to Termination

Name of Learner (Print) / Signature of Learner / Date

Employer Agreement to Termination

Name of Lead Employer / Signature of Lead Employer Representative / Date

Training Provider Agreement to Termination

Name of Lead Training Provider / Signature of Lead Training Provider Representative / Date

Note: By signing this document, the Learner/Lead Employer/Lead Training Provider acknowledges that all rights and obligations with regard to this Learnership will have terminated.

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Learnership Agreement Termination Report