Registration Form

Full Name: *

Please provide your name as listed on your Passport or Birth Certificate

Date of Birth: *

MSD Client number (if you have an existing number):

If you do not have a number, click here to request a client number form from Work and Income

Please tick the following:

I would like to enrol for the next available Dressed in Confidence programme available
I have access to wifi

Do you give permission for the following? (please tick):

Register with MSD as a job seeker
If you do not have a MSD client number already
Agree to share this form with MSD
Approve to share your identification documents with MSD to check your eligibility for this programme

Select Programmed *

Mobile Number: *

Email: *

City: *

Electronic Signature: *

Date: *

Proudly supported by the Ministry of Social Development