Child Justice Act, 2008 (Act No. 75 of 2008)

Regulations

Purchase

Form 11

NOMINATION OF INDEPENDENT OBSERVER

SECTION 1 READ WITH SECTION 65 OF THE CHILD JUSTICE ACT, 2008 (ACT NO. 75 OF 2008)

REGULATIONS RELATING TO CHILD JUSTICE

(Regulation 38)

PART A: NOMINATION

Personal Particulars of the Nominator

Full names and surname
ID No.
Physical Address:



Contact details: (Home, work and cellphone number or email address)
Name and contact details of institution represented, if applicable

Particulars of the nominee

Full names and surname
ID No:
Physical address:



Contact details: (Home, work and cellphone number or email address)


Reason for nomination:

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Signature: Nominator

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Date:

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Place

PART B: ACCEPTANCE OF NOMINATION

Full names and surname
ID No:
Physical Address:



Contact details: (Home, work and cellphone number or email address)


Language Proficiency:
Occupation:
Have you ever been convicted of an offence?
Background Information: (Include cultural background and social interest, in particular the welfare and interests of children)













Membership details: (other membership or positions held)


Other information relevant for purposes of nomination as an independent observer:

I declare that the information provided above is to the best of my knowledge and belief true and correct.

I accept the nomination to serve as an independent observer and declare myself a fit and proper person for nomination.

I accept that serving as an independent observer is a social responsibility and that I do not expect any payment for services rendered.

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Signature: Nominee

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Date:

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Place