Mandating Procedures of Provinces Act, 2008
R 385
Immigration Act, 2002 (Act No. 13 of 2002)RegulationsImmigration Regulations, 2014AnnexuresAnnexure A: FormsForm 10 (DHA-1739) |
(DHA-1739) Form 10
APPLICATION FOR RENEWAL OF EXISTING VISA
[Section 10(7); Regulation 9(9)]
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For official use only |
Track & Trace Ref No:
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BLOK: |
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Office of application
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File No: |
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Date received:
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Date forwarded to Head Office: |
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Submission quality checked by:
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Date received at Head Office:
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Remarks: |
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Passport checked and returned by ................................................................ Date: ...................................................... Persal number: ...................................... |
Decision ....................................... Date: ............................................ Persal number: ............................. |
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Receipt no for fee paid
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Conditions of visa / reason(s) for refusal: .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ....................................................................................................................................
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IMPORTANT:
An application for the renewal of a visa must be submitted in person at least 60 days prior to the expiry date of the existing visa. |
PARTICULARS OF APPLICANT:
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Surname/Family name: |
First name(s): |
Date of birth: |
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Residential address in the Republic: |
........................................................................................................ ......................................................................................................... ......................................................................................................... ......................................................................................................... |
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Telephone No.: |
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Home Telephone No. |
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Cellphone No.: |
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E-mail address: |
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PASSPORT DETAILS:
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Passport number: |
Issuing country: |
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Date of issue: |
Valid until: |
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If you have any other identity document issued by your government, provide details:
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Type of document: |
Number: |
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Date of issue: |
Expiry date: |
DETAILS OF ORIGINAL VISA, AS ISSUED TO YOU PRIOR TO OR ON ARRIVAL IN SOUTH AFRICA:
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Date of entry: |
Visa No: |
Type of visa:
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Place of entry: |
Date of expiry: |
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Purpose of entry: |
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DETAILS OF ANY SUBSEQUENT VISA ISSUED TO YOU, OR THE MOST RECENT RENEWAL THEREOF:
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Type of visa: |
Issued at: |
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Date of issue/renewal: |
Date of expiry: |
A visa is required until ............................(date) for purposes of ...................................................
..................................................................................................................................................... (state reason(s) for request).
The relevant documents in support of your application for the renewal of an existing visa must be attached.
DECLARATION BY APPLICANT
I acknowledge that I understand the content of this application and solemnly declare that the above particulars provided by me are true and correct.
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Signature of applicant
Signed at ............................................ on this .......... day of ....................................... 20 ..........
