In the Magistrate's Court for the District/Region of ....................................................held at ......................................... Case No. ........................................ of 20.........

In the matter between

.................................................................................................................Judgment Creditor

and

................................................................................................................. Judgment Debtor

Whereas the said ................................... on the .............................. day of ..........................., 20...... obtained judgment in this court against the said ................................. for the sum of R......... together with a sum of R............. for costs;

And whereas the said .................................. has applied to the court for a stay of execution pending appeal/review proceedings and the court has directed that execution be stayed accordingly subject to the said ................................ giving security within ............... days;

Now, therefore, the said .................................. and .............................. of ............................... as surety and co-principal debtor for the said .................hereby bind themselves jointly and severally to satisfy the said judgment and any further liability which may arise by way of damages or otherwise by reason of such suspension, so far as such judgment may not be reversed or varied on appeal/review; and further severally ............................... (insert any further terms required).

Signed at .................................. this ............................ day of .............................., 20.......,

.

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

Judgment Debtor

Witnesses:

1.         ................................................................

Signature and address

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

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

Surety and co-principal debtor

2.         ................................................................

Signature and address

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