Fillable FORM B: AUTHORIZATION BY WITNESS OR PROSPECTIVE WITNESS (South Africa Department of Justice and Constitutional Development)

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FORM B: AUTHORIZATION BY WITNESS OR PROSPECTIVE WITNESS (South Africa Department of Justice and Constitutional Development)

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REPUBLIC OF SOUTH AFRICA
FORM B
AUTHORIZATION BY WITNESS OR PROSPECTIVE WITNESS TO BE
DETAINED IN OR PLACED UNDER PROTECTIVE CUSTODY
1. I, ................................................................................................................................................................... ,
* witness/prospective witness, hereby give authorization that I -
* (i) be detained in protective custody;
or
* (ii) be placed under protective custody.
2. I have the following physical injuries:
………………..................................................................................................................................................
.......................................................................................................................................................................
..................................................................................................................................................................... a)
3. I, ……………………………………................................................................................................................. ,
hereby declare that the above-mentioned information is, to the best of my knowledge, true, complete and
correct and that I am aware of the fact that it is an offence if I wilfully furnish information or make a
statement which is false or misleading.
.................................................................................
(Signature/mark/thumbpirnt of deponent)
4. I,.................................................................................................................................................................... ,
*parent/guardian of the above-mentioned witness, hereby give authorization for the above-mentioned
person to be so protected.
..................................................................................
(Signature/mark/thumbpirnt of parent/guardian)
5. I, ................................................................................................................................................................... ,
hereby certify that I have interpreted truly and to the best of my abilities correctly in relation to the contents
of this statement and any question put to the deponent by the member.
...............................................................
(Signature of interpreter)
FORM B - AUTHORIZATION BY WITNESS OR PROSPECTIVE WITNESS TO BE DETAINED IN OR PLACED
UNDER PROTECTIVE CUSTODY
Page 2 of 2
...........................................................
(Full name)
...............................................................
[Designation (Rank)]
..................................................................
..................................................................
..................................................................
..................................................................
(Address of employment)
6. I, ................................................................................................................................................................... ,
hereby certify that before the deponent affixed * his/her mark, thumbprint or signature to this form, I read
the statement to * him/her and informed * him/her that it is an offence wilfully to furnish information or make
a statement which is false or misleading.
...............................................................
(Signature of official)
...........................................................
(Full name)
...............................................................
[Designation (Rank)]
..................................................................
..................................................................
..................................................................
..................................................................
(Address of employment)
Remarks:
a) Attach medical certificate (if available).
* Delete whichever is not applicable.
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FORM B: AUTHORIZATION BY WITNESS OR PROSPECTIVE WITNESS (South Africa Department of Justice and Constitutional Development)

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Completed 21 June 2021

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