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Disaster Management Act, 2002 (Act No. 57 of 2002)

Regulations

Regulations Issued in terms of Section 27(2) of the Disaster Management Act, 2002

Annexures

Annexure C - Forms

Form 3-Sworn Affidavit by person who wishes to attend a funeral in another Metropolitan area, District or Province (Regulation 11B(8)(d))

 

ANNEXURE C

FORM 3

SWORN AFFIDAVIT BY PERSON WHO WISHES TO ATTEND A FUNERAL IN ANOTHER METROPOLITAN AREA, DISTRICT OR PROVINCE

Regulation 11B(8)(d)

 

Note:

1. A person giving false information on this affidavit shall be guilty of an offence and, on conviction, liable to a fine or to imprisonment for a period not exceeding six months or to both such fine and imprisonment.
2. This affidavit may only be sworn to or affirmed at a magistrate's court or police station.

 

Full Names:

Surname:

Identity number:

Address of place of residence:

Province of residence:

Contact details:

Cell nr.

Tel No (h)

Email Address



Metropolitan area/district of funeral/cremation:

Province in which funeral/cremation will take place:

 

Hereby declare under oath with regards to the deceased:

Names of deceased:

Surname of deceased:

Relationship/Affiliation

to the deceased (eg

spouse/parent/friend

etc)

I am the person

making the funeral

arrangements/applies

for the issue of a

death certificate

(mark with an X):

YES

 

NO

Date of funeral/cremation

Province in which funeral/cremation will take place

*City/town/village of

funeral:

 

*OATH/AFFIRMATION

 

I,_____________________________________(full names), identity number

 

_______________________________________, hereby declare under *oath/affirmation that the above-mentioned information is true and correct.

 

 

Signed at ___________ on this the _____________ day of____________________2020

 

 

_____________________________

Signature of person making affidavit

 

CERTIFICATION

 

I hereby certify that before administering the *oath/taking the affirmation, I asked the sheriff(deponent) the following questions and noted *his/her answers in *his/her 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 *oath/affirmation?

Answer: ___________________

(c) Do you consider the *oath/affirmation to be binding on your conscience?

Answer: ___________________

 

I hereby certify that the sheriff (deponent) has acknowledged that *he/she knows and understands the content of this declaration which was *sworn to/affirmed before me, and the sheriff's(deponent's) signature was placed thereon in my presence.

 

 

Signed at___________________this________day of______________2020.

 

 

_______________________________________

*Justice of the Peace/Commissioner of Oaths

 

Full names: ________________________________________________________

 

Designation: ________________________________________________________

 

Business address: __________________________________________________

__________________________________________________

__________________________________________________

 

*Delete which is not applicable

 

[Annexure C, Form 3 substituted by section 15 of Notice No. R. 465, GG43232, dated 16 April 2020]

[Annexure C, Form 3 inserted by section 8 of Notice No. R.446, GG43199, dated 2 April 2020]