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Immigration Act, 2002 (Act No. 13 of 2002)

Regulations

Immigration Regulations, 2014

Annexures

Annexure A: Forms

Form 17 (DHA-1732)

 

(DHA-1732) Form 17

 

Dept of Home Affairs Icon

 

ASYLUM TRANSIT VISA

 

[Section 7(1)(g) read with section 23(1); Regulation 22]

 

To be completed at a Port of Entry or any other place designated by the Director-General by a person who declares his or her intention to apply for asylum in terms of the Refugees Act, 1998. To be completed in black ink with BLOCK LETTERS

 

PART A

 

PERSONAL DETAILS OF APPLICANT

 

Surname/Family name











Name(s) in full
























Date of Birth

C

C

Y

Y

M

M

D

D

Passport No.








(Where applicable)

 

Identity No.








(Where applicable)

 

Sex (write in full)











Country of Birth











Province











Place of Birth











Current Nationality











Previous nationality(ies)

(Where applicable):

 

Ethnic Group

Language spoken

Level of fluency in English

Read (please tick the appropriate box)

 

Good

Fair

Poor

Write (please tick the appropriate box)

 

Good

Fair

Poor

Other Languages

(a)

 











 

 

(b)











Religion











Marital status (please tick the appropriate box)

Single

Married

Divorced

Widow

Widower

Type of Marriage:

(please tick the appropriate box)

Civil Union

Religious

Customary

Other (specify)

 

 

Number of spouses


Occupation/Profession











Residential address during the last year



































Address in the RSA


















































Contact details of person in RSA

 

 

Surname/Family name

Name(s) in full

Contact number (personal, if any)

Contact details of person in RSA

 

 

Details of dependants (below 18 years of age accompanying applicant)

 

Dependant 1

Surname/Family name











Name(s) in full
























Date of Birth

C

C

Y

Y

M

M

D

D

Passport No.

 








(Where applicable)

Identity No.

 








(Where applicable)

Sex (write in full)











Country of Birth











Province











Place of Birth











Current Nationality











Dependant 2

Surname/Family name











Name(s) in full
























Date of Birth

C

C

Y

Y

M

M

D

D

Passport No.

 








(Where applicable)

Identity No.

 








(Where applicable)

Sex (write in full)











Country of Birth











Province











Place of Birth











Current Nationality











Dependant 3











Surname/Family name











Name(s) in full
























Date of Birth

C

C

Y

Y

M

M

D

D

Passport No.

 








(Where applicable)

Identity No.

 








(Where applicable)

Sex (write in full)











Country of Birth











Province











Place of Birth











Current Nationality











Dependant 4











Surname/ Family name











Name(s) in full











Date of Birth

C

C

Y

Y

M

M

D

D

Passport No.

 








(Where applicable)

Identity No.

 








(Where applicable)

Sex (write in full)











Country of Birth











Province











Place of Birth











Current Nationality











 

 

PART B

 

DECLARATION BY APPLICANT

 

 

I, the undersigned Surname/Family Name.............................................................................................................................................................................................................................

(first name (s)........................................................................................................................................................................................................................................................................

 

Declare that—

• I am seeking asylum in the Republic; and
• I *have/have not previously applied for asylum in the Republic.
• I understand that if I have made a false statement I shall be guilty of an offence and liable on conviction to a fine or imprisonment.
• I understand that I must report to a designated Refugee Reception Office within 5 working days to submit my application for asylum, that my visa to report to a Refugee Reception Office may not be renewed and that upon expiry thereof, I shall become an illegal foreigner.

 

 

..................................................................                                                            .....................................................

Signature of applicant                                                                                                              Date

 

 

 

 

 

Left thumb print                                                                                                                                                            Photograph

 

Note: If the asylum seeker is accompanied by dependents, their names, surnames, gender and dates of birth must be indicated on this Form as well as the left thumb print and photograph of each person accompanying that asylum seeker.

 

 

 

.........................................................................

Signature of immigration officer

 

 

Surname: ............................................................................................

Official stamp

First name(s): ......................................................................................

Rank/position: .....................................................................................

Date: ...................................................................................................

Place: ..................................................................................................

Appointment / Persal No.: ...................................................................

 

 

*Delete whichever is not applicable