L
FV
SV
CT
P
Y
NO
Confirmation of Residential / Business
Address by Third Party
Individual
Type:
Trust
Company/
CC
Partnership
Third Party Details (to be completed by the person providing proof of residence)
Personal Details
Note: A copy of the proof of residential/business address must accompany this declaration
Surname
First Two
Names
Initials
Date of Birth
(CCYYMMDD)
ID No.
Passport Country (e.g.
South Africa = ZAF)
Passport
No.
Contact Details
Contact
Email
Cell No.
Home Tel
No.
Bus Tel
No.
Unit No.
Street No.
Suburb/
District
City/
Town
Postal
Code
Street / Farm
Name
Complex (if
applicable)
Country Code
(e.g. South Africa = ZA)
Physical Address (the address being confirmed)
Relationship to Taxpayer/Entity
Lessor
Landlord
Property/Estate Agency
Owner
Other (Please
specify)
Councillor/Traditional Leader
If 'other' provide details:
Date
(CCYYMMDD)
For enquiries go to www.sars.gov.za or
call 0800 00 7277
Declaration
I hereby declare that the residential /
business address being confirmed
is true and correct.
I confirm that the taxpayer reflected,
resides / carries on business at the
aforementioned address.
xxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxx
Please ensure you sign over
the 2 lines of “X”s above
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L
FV
SV
CT
P
Y
NO
Details of Taxpayer (requesting change or confirmation of physical address)
Surname
First Two
Names
Initials
Date of Birth
(CCYYMMDD)
ID No.
Passport Country (e.g.
South Africa = ZAF)
Passport
No.
Taxpayer
Reference No.
Entity Details
Registered
Name
Trading
Name
Registered
No.
Taxpayer
Reference No.
Contact Details
Contact
Email
Cell No.
Home Tel
No.
Bus Tel
No.
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