AFFIDAVIT FOR A NATURAL PERSON
I, the undersigned,
(Full names)
(South African Identity Number)
hereby declare under oath as follows, that –
1.
I am a “Black Person” as defined in the Broad-Based Black Economic Empowerment Codes of Good Practice
gazetted from time to time under the Broad-Based Black Economic Empowerment Act, No. 53 of 2003, as this
definition of interpreted by the courts from time to time;
2.
#I became a South African citizen by birth/descent before the commencement date of the constitution of the
Republic of South Africa Act of 1993, being prior to 27 April 1994;
3.
#I became a South African citizen by naturalisation before the commencement date of the constitution of the
Republic of South Africa Act of 1993, being prior to 27 April 1994;
4.
#I became a South African citizen by naturalisation after the commencement date of the constitution of the
Republic of South Africa Act of 1993, being prior to 27 April 1994, but I would have qualified for South African
naturalisation prior to 27 April 1994 in the absence of the laws governing the apartheid regime;
5.
the certified copy of my identity document attached to this affidavit is true and complete and is verifiable proof of
the above declarations.
#Delete the above if not applicable
Further to this:
1.
I acknowledge that SAB ZENZELE KABILI (PTY) LTD and its agents are committed to protecting and
promoting the privacy of my Personal Information and to give effect to the constitutional right to privacy and
to fulfil its obligations under the Protection of Personal Information Act No 4 of 2013 (Hereinafter ‘POPI’).
2.
I hereby give consent to SAB ZENZELE KABILI (PTY) LTD and its agents to process my Personal
Information where the processing is necessary and only for purposes of conducting checks and verifications
of the facts contained in this affidavit.
3.
SAB ZENZELE KABILI (PTY) LTD and its agents acknowledge and agree that the Personal Information will
not, under any circumstances, be processed for purposes prohibited by POPI and/or the principles
contained in POPI and that the processing of Personal Information will be done fairly and in accordance with
legal provisions, given that the purpose for which processing of the Personal Information is adequate,
relevant and not excessive.
4.
I herewith defend, indemnify and hold harmless SAB ZENZELE KABILI (PTY) LTD and its agents from any
action or claim of any nature whatsoever that might be brought by any person whatsoever against SAB
ZENZELE KABILI (PTY) LTD and its agents as a result of any personal loss, injury or damage arising
directly or indirectly from any act or omission on my part relating to or incidental to the failure from my part to
honour the above provisions, or otherwise, as the case may be.
[Signature]
[FULL NAME OF DEPONENT]
I certify that the deponent has acknowledged that he/she knows and understands the contents of this affidavit, that
he/she has no objection to taking the prescribed oath and that he/she considers it binding upon his/her conscience.
Thus signed and sworn to before me at _[Place] on _ [Date].
COMMISSIONER OF OATHS
FULL NAMES:
DESIGNATION:
STREET ADDRESS:
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