ANNEXURE 4

(Section 11(2) of Act No. 68 of 1997: Regulation 6(3))

CONSENT TO CHANGE PLACE OF ORDINARY RESIDENCE OR POSTAL ADDRESS

TO:        (state full names)

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(state surname)

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Identity number

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Residential address

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Please note that according to my records your residential and/or postal address has/have changed permanently to the address mentioned above.

Should you confirm the change of address by signing this form below and return same to the address at the back thereof, your address particulars will be changed accordingly in the Population Register.

DIRECTOR-GENERAL: HOME AFFAIRS

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

OFFICIAL

The Director-General: Home Affairs

Private Bag X200

PRETORIA

0001

I hereby give consent to the changing of the address particulars in the Population Register.

SIGNATURE  .......................................................................................

DATE:         ...........................................................................................