(DHA-1723) Form 26

RECEIPT OF ITEMS SEIZED

[Section 7(1)(g) read with section 33(5)(c); Regulation 32(5)]

This form is to be completed in triplicate

I, .................................................................................................................................................. (name and surname of immigration officer) hereby acknowledge that I have seized the following items in terms of section 33(5)(c) of the Act from the premises of .............................................................................................................. in the district of ................................................................................................................................................

Total no of items seized: .........................................................................................................

Confirmed by: ....................................................................... (name(s) and surname of person in charge of premises) in his or her capacity as ...............................................................

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

Signature of person in charge of premises

Signed at .................................................................................... on this ................ day of .........................................................................20..................

IMMIGRATION OFFICER'S PARTICULARS

Name and Surname: ........................................................................................................................................................................................................

Appointment number: .....................................................................................................................................................................................................

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

Office: ............................................................................................ Province : ................................................................................................................

SUPERVISOR'S PARTICULARS

Name and Surname: .........................................................................................................................................................................................................

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

Contact No.: Tel: ..............................................................................................................................................................................................................

ACKNOWLEDGEMENT OF RECEIPT OF ITEMS RETURNED

I hereby acknowledge receipt of the items that were seized and removed from ......................................................................................................................................................................... (premises) on ............./................................/.................. (date) and confirm that all items have been received in good order or ..........................................................................................................................................

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

Signature of person in charge of premises                                                                                                 Date: