Mandating Procedures of Provinces Act, 2008
R 385
Immigration Act, 2002 (Act No. 13 of 2002)RegulationsImmigration Regulations, 2014AnnexuresAnnexure A: FormsForm 12 (DHA-1712A) Part B |
(DHA-1712A) Form 12
AFFIDAVIT IN RESPECT OF PARTIES TO PERMANENT HOMOSEXUAL OR
HETEROSEXUAL RELATIONSHIP
[Section 7(1)(g), read with sections 11(6) and 26(b); Regulations 3(2) and (4)]
PART B
TO BE COMPLETED IN ORDER TO DEMONSTRATE THAT THE SPOUSAL RELATIONSHIP CONTINUES TO EXIST TWO YEARS AFTER THE ISSUANCE OF THE VISA OR PERMIT
Particulars of citizen / permanent resident / foreigner*
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Surname: ........................................................... |
Gender: |
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First name(s): .................................................................................................................. Residential address: ......................................................................................................... ......................................................................................................................................... .......................................................................................................................................... |
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Identity No.
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Or: Passport No.: ........................................................ Nationality: ................................................. Date of birth: .............................................................................................. Date of first entry into the Republic: ................................Type of permit: ................................. Date of expiry of permit: ................................................. |
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Particulars of foreigner
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Surname: .................................................................. |
Gender: |
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First name(s): ..........................................................................................................................
Residential address: ................................................................................................................ ................................................................................................................................................ Passport No: ........................................................................ Date of birth: .............................. Place of birth: .......................................................................................................................... Nationality: .............................. Date of first entry into the Republic: ....................................... Type of visa/permit held: ...................................................Date of expiry: ............................. |
I, ................................................................................................................(name and surname) being an *unmarried/divorced/widowed person and ............................................................................(name and surname) being an *unmarried/divorced/widowed person do hereby *make oath and say/hereby solemnly affirm that on ...................................................................... (date) we deposed to an affidavit confirming that we are parties to a spousal relationship. We are not married and the spousal relationship mentioned in the preceding paragraph still subsists with all the characteristics mentioned in Part A of this Form.
We are the parents of the following children:
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Name of child |
Date of birth |
Name of mother of child |
Name of father of child |
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| Signature of spouse | Signature of spouse |
Thus signed and *sworn/solemnly affirmed before me on this ......... day of ...................................
20 ....................................
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.............................................................. Commissioner of Oaths |
OFFICE STAMP |
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First name(s): ...................................................................................... |
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Surname: ............................................................................................. |
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Capacity:.............................................................................................. |
Place: ...................................................................................................
*Delete which is not applicable
