Fillable AFFIDAVIT (South Africa Department of Justice and Constitutional Development)

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AFFIDAVIT (South Africa Department of Justice and Constitutional Development)

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DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT
GP-S 81/811521
J192
(81/811521)
REPUBLIC OF SOUTH AFRICA
AFFIDAVIT
PARTICULARS OF NEXT-OF-KIN
I, ..............................................................................................................................................................
of..............................................................................................................................................................
.................................................................................................................................................................
*do hereby make oath and say/affirm that within is a true and complete statement of the next-of-kin of
the deceased, and I make this statement conscientiously, believing the same to be true.
...................................................................... ......................................................................
Signature Print Name and Surname
Signed and *sworn to/affirmed before me
at………………………………………………………………………………………….
this............................... day of........................................... in the year.
The deponent has acknowledged that he/she knows and understands the contents of this affidavit
and adheres to it.
………………………………………………………………….
*Magistrate/Justice of the Peace/Commissioner of Oaths
Area for which appointed ......................................................................................................................
If appointment is held ex officio, state office held..................................................................................
* Delete if not applicable.
J192
DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT
2
* Separate affidavits in respect of each predeceased child must be completed.
Names and addresses of the next-of-kin of the late................................................................................................................
who died at............................................................................................................ on ...........................................................
(Place) (Date)
N.B.: The date of death is to be inserted opposite the name of any deceased relative. Against those degrees of
relationship in which the deceased never had any relative, the word "NONE" is to be inserted.
Relatives to be accounted
Names of relatives and degree of relationship
1. Surviving spouse:
2. Children and date of their birth. Also state names of
*predeceased children and their dates of death:
Ignore questions 3, 4 and 5 if the deceased left children
or descendants.
3. Father of deceased:
Mother of deceased:
Ignore questions 4 and 5 if the parents are both alive.
4 Brothers and sisters of the deceased. State whether
full or half blood, and their addresses and dates of birth.
State the name of the step-parent of half brothers and
half sisters:
5. Names of brothers and sisters who are dead, date of
deaths, and names, addresses and dates of birth of their
children, if any
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AFFIDAVIT (South Africa Department of Justice and Constitutional Development)

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Completed 6 July 2021

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