J341A
DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT
D. BANK DETAILS OF THE APPLICANT
The Director General : Department of Justice and Constitutional Development
I hereby request and authorise you to pay any amounts in respect of Guardians Fund which may accrue to me to the credit of my / our account with
the authorised financial services provider mentioned below.
I understand that the credit transfers hereby authorised will be processed electronically to the account specified below. I also understand that any
banking costs for transactions (withdrawals/bank statements/etc.) made on the account will be borne by me. The Department of Justice &
Constitutional Development will not be liable for any banking costs on the account. I also hereby indemnify the Department of Justice &
Constitutional Development for any incorrect detail and information that may have been specified on this form.
Name and
Physical
Address of
Bank:
Name of Bank Official: ……………………………………………………………………..
Signature of Bank Official:………………………………………………………………..
E. CERTIFICATE OF MAINTENANCE
I, …………………………………………………………………… the undersigned, certify that the aforementioned minor(s)
has/have been properly maintained by the applicant during the period from ………………………………………………. to
…………………………………………………………………………. and recommend that the allowance/maintenance
applied for be granted to the applicant.
NAME: …………………………………………………………………. SIGNATURE: …………………………………..
CAPACITY: ……………………………………………………………. Responsible person (i.e. Maintenance Officer/school
teacher/Minister of Religion/Social Worker/Tribal
Authorities or other responsible person)
DATE: …………………………………………………………………..
PLACE: ………………………………………………………………..
Stamp of Institution
I ……………………………………………………………………………………………the undersigned hereby confirm that all
the above mentioned information stated above is true and correct.
Signed at……………………………….…………………..on this…………….day of………………………………..20…….…….
Signature of Applicant: ………………………………….. Relationship to Minor: …………………………………………..
Signature of minor: (10 years or older) ………………………………………………..
APPLICATION
APPROVED / NOT APPROVED