Fillable FORM 12: AFFIDAVIT BY MEMBER OF SOUTH AFRICAN (South Africa Department of Justice and Constitutional Development)

Fill Online, Printable, Fillable, Blank FORM 12: AFFIDAVIT BY MEMBER OF SOUTH AFRICAN (South Africa Department of Justice and Constitutional Development) Form

Use Fill to complete blank online SOUTH AFRICA DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

FORM 12: AFFIDAVIT BY MEMBER OF SOUTH AFRICAN (South Africa Department of Justice and Constitutional Development)

On average this form takes 7 minutes to complete

The FORM 12: AFFIDAVIT BY MEMBER OF SOUTH AFRICAN (South Africa Department of Justice and Constitutional Development) form is 2 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 29 other fields

Country of origin: SOUTH-AFRICA
File type: PDF

Use our library of forms to quickly fill and sign your South Africa Department of Justice and Constitutional Development forms online.

BROWSE SOUTH AFRICA DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Department of Justice and Constitutional Development
1
J100
REPUBLIC OF SOUTH AFRICA
FORM 12
[Regulation 14]
AFFIDAVIT BY MEMBER OF SOUTH AFRICAN POLICE SERVICE TO FURNISH
INFORMATION TO COURT
SECTION 5(3)(a) OF THE PROTECTION FROM HARASSMENT ACT, 2011 (ACT NO. 17 OF 2011)
(CONFIDENTIAL)
(MUST BE COMPLETED IN DUPLICATE)
APPLICATION NO. ……………………..……/20 …… DIRECTION NO………….…….……./20……
To: ……………………………..…………………………………………….. (name and surname of clerk of the court
identified in the direction)
Facsimile number: ………………………………….………………..
From (particulars of person making affidavit):
Name and surname: ………………………..………………………………..……..………………………………..
Telephone number: …………………………………………………..……………………………………………..
Physical address: ……………....…………………………………………………………………………
……………..…………………………………………………………………………..
……………..…………………………………………………………………………..
Rank: ………………………………………………………………………………………….
Persal number: ………………………………………………………………………………………….
hereby states as follows:
1. In terms of the direction of the court I was ordered to investigate the alleged harassment of the
complainant/related person with a view to determining the name and address or any other information
which may be required in order to identify or trace the respondent.
2. As a result of the investigation the following information of the respondent has been obtained:
2.1 Name and surname of respondent: ……………………………………………………………………..
……………………………………………………………………………..………………………………………
2.2 Address of respondent: ………………………………………….……………………………………….
…………………………………………………………………………..…………………………………………
……………………………………………………………………………………………………………………..
2.3 The following additional information has been acquired in order to identify or trace the respondent:
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
J100
Department of Justice and Constitutional Development
2
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………….
(Any documentation acquired which may be used to identify or trace the respondent must be attached
as an annexure to this form.)
………………………………………… ……………………………………
Signature of Deponent Date
I certify that before administering the *oath / taking the affirmation I asked the Deponent the following
questions and noted *her/his answers in *her/his presence as indicated below:-
(a) Do you know and understand the contents of the above declaration? Answer …………...
(b) Do you have any objection to taking the prescribed oath? Answer …………...
(c) Do you consider the prescribed oath to be binding on your conscience? Answer …………...
I certify that the Deponent has acknowledged that *she/he knows and understands the contents of this
declaration which was *sworn to / affirmed before me, and the Deponent's signature was placed thereon
in my presence.
Dated at ………………………………………….……. this ……….. day of ……………….……….. 20………
______________________________________
Justice of the Peace / Commissioner of Oaths
Full Names: …………………………………………………………………………………………………………..
Designation: ………………………………………………………………………………………………………….
Area for which appointed: …………………………………………………………………………………………..
Business Address: ……………………….…………………………………………………………………………
………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………….
To be completed by the clerk of the court on receipt of the affidavit:
I, ……………………………………………………………………………….…….. (name and surname of
clerk of the court), hereby certify that I have received this affidavit from …………………………………
………………………………………………………………. (name and surname of person who furnished
the affidavit to clerk of the court) on …………………………… (date).
________________________
Signature of clerk of the court
(CONFIDENTIAL)
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

FORM 12: AFFIDAVIT BY MEMBER OF SOUTH AFRICAN (South Africa Department of Justice and Constitutional Development)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 June 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document