DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT
J767
REPUBLIC OF SOUTH AFRICA
FORM 2
BRINGING MATTER TO COURT IN TERMS OF SECTION 53 CHILDREN'S ACT, 2005 (ACT NO. 38 OF 2005)
REGULATIONS RELATING TO CHILDREN'S COURTS AND INTERNATIONAL CHILD ABDUCTION, 2008
[Regulation 6]
Note:
1. Affidavits of other persons or other documentary evidence in support of the matter must be attached.
2. Your attention is drawn to the fact that the children's court may adjudicate the matter, refer the matter for
mediation to a lay-forum or refer the matter for a family group conference. If the matter is referred back
to the children's court the clerk will inform you accordingly.
File No:….........................................................….
[If the space provided for is inadequate, submit information as an Annexure to this form and sign each page.]
PART A: PARTICULARS OF CHILD(REN)
Surname:
Full names and gender:
Child 1
Child 2
Child 3
Child 4
Child 5
ID. No./Date of birth: Child 1
/ /
Child 2
/ /
Child 3
/ /
Child 4
/ /
Child 5
/ /
Residential address(es):
(If the addresses are not the same for
each child please indicate the addresses
on a separate page.)
Code ( )
Residential telephone number: (if any) (If
the numbers are not the same for each
child please indicate the numbers on a
separate page.)
Cellular number:(if any) Child 1
Child 2
Child 3
Child 4
Child 5
Physical address (where documents can
be served): (If the addresses are not the
same for each child please indicate the
addresses on a separate page.)
Code ( )
J767
DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT
2
Other relevant information (such as
financial position, availability of transport,
socio-economic status, if an interpreter
will be needed and if special
requirements are needed e.g. wheelchair
access) which may assist the court to
make a decision regarding the manner in
which the matter could best be dealt with
in terms of the Children's Act, 2005 (Act
No. 38 of 2005)
PART B: PARTICULARS OF *CHILD WHO IS AFFECTED BY OR INVOLVED IN THE MATTER/PERSON *ACTING
IN THE INTEREST OF THE CHILD/*ON BEHALF OF THE CHILD WHO CANNOT ACT IN HIS/HER OWN NAME/
*MEMBER OF A GROUP OF CLASS OF CHILDREN/*IN THE PUBLIC INTEREST (SECTION 53(2))
Surname:
Full names
ID. No./Date of birth:
/ /
Capacity or relationship of person acting in
terms of section 53(2):
Registration number of corporate body(if
applicable):
Residential address:
Code ( )
Residential telephone number:
Cellular telephone number:
Work address:
Code ( )
Work telephone number:
Fax number:
Physical address (where documents can
be served):
Code ( )
E-mail address:
J767
DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT
3
PART C: PARTICULARS OF PERSONS HAVING AN INTEREST IN THE MATTER
Surname:
Full names
ID. No./Date of birth:
/ /
Capacity of person acting in terms of
section 53(2)(b)-(e):
Registration number of corporate body(if
applicable):
Residential address:
Code ( )
Residential telephone number:
Cellular telephone number:
Work address:
Code ( )
Work telephone number:
Fax number:
Physical address (where documents can
be served):
Code ( )
E-mail address:
PART C
PARTICULARS OF PERSONS HAVING AN INTEREST IN THE MATTER
Surname:
Full names:
ID. No./Date of birth:
/ /
Capacity of person acting in
terms of section 53(2)(b)-(e):
Registration number of
corporate body: (if applicable)
Residential address(if
applicable):
Code ( )
Phone number(h):
( )
Cellular phone number:
J767
DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT
4
Business address:
Code ( )
Phone number(b):
( )
Fax number:
( )
Physical address (where
documents can be served):
Code ( )
E-mail address:
PART D:
PARTICULARS OF MATTER
Nature of matter brought to court:
(Please give full details of the matter
e.g., registration/amendment of
parenting plans, removal of child to
safe care, children in need of care
and protection, placement in youth
care centers, adoption etc.)
Documents: Are there any
documents relating to the matter?
(If so please attach):
Signed at ……………………..........................................………………..this…………..day of………......…………20…….
……………………………………………………………………………..
Signature/thumbprint/mark of person bringing the matter to court
……………………………………………………………………………….
Full names of person witnessing person who made a thumbprint/mark
………………………………………………………………………………...
Signature of witness to thumbprint/mark
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