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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 (COVID-19)

Annexures

Annexure A : Forms

Form 5 : Sworn Affidavit by person who wishes to attend a Funeral in another Province/Metropolitan Area/District

 

FORM 5

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

Regulations 18(7)

 

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.

 

I,

Full Names:

Surname:

Identity number:

Address of place of residence:

Province of residence:

Contact details:

Cell nr.

Tel No (h)

Email Address



District of funeral:

 

Province in which funeral 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)

I am not in possession of the death certificate for the reasons set out, and a copy of the letter from a cultural or religious leader is attached:

Yes

 

No

Date of funeral:

 

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

 

 

Signed at ___________________ on this ________ day of ______________ 2020.

 

 

_______________________________________

*Justice of the Peace/Commissioner of Oaths

 

Full names: ________________________________________________________

Designation: ________________________________________________________

Business address: __________________________________________________

__________________________________________________

__________________________________________________

 

*Delete which is not applicable