Acts Online
GT Shield

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

Regulations

Regulations relating to Child Justice

Annexure

Form 5 : Sworn statement in respect of placement of child

 

Form 5

 

SWORN STATEMENT IN RESPECT OF PLACEMENT OF CHILD

SECTIONS 29(4) AND 40(2) OF THE CHILD JUSTICE ACT, 2008 (ACT NO. 75 OF 2008)

REGULATIONS RELATING TO CHILD JUSTICE

[Regulations 23 and 27]

 

 

Particulars of the child (furnish particulars to the extent known)

Full names and surname

Age

Date of birth:

Sex:

 

I, ............................................................................................... state under oath that:

 

1. I am responsible for the management of ..................................................... Child and Youth Care Centre.

 

2. I confirm that this Centre has capacity to accommodate .............children and at present the Centre is accommodating ............... children. The Centre is accordingly.

 

(Tick the appropriate box)

in a position to accommodate the above-mentioned child

 

not in a position to accommodate the above-mentioned child

 

3. The Centre is equipped with:

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

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

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

(State features and amenities)

 

4. The Centre is safe and secure as:

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

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

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

(Describe security measures installed at the Centre)

 

 

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

Signature: Manager

 

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

Date

 

 

OATH/DECLARATION

 

I certify that prior to administering the oath/affirmation. I asked the deponent the following questions and recorded his/her answers in his/her presence:

 

Do you know and understand the contents of the above statement? ...........................
Do you have any objection to taking the prescribed oath? ...........................
Do you consider the oath to be binding on your conscience? ...........................

 

I certify that the deponent has acknowledged that he/she understands the contents of this declaration. The deponent uttered the following words— "I swear that the contents of this declaration are true, so help me God" / "I truly affirm that the contents of the declaration are true". The signature/thumb print/mark of the deponent was placed thereon in my presence.

 

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

 

 

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

Commissioner of Oaths

 

Full names: ................................................................................
Designation: ................................................................................
Area: ................................................................................
Business Address: ................................................................................