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Immigration Act, 2002 (Act No. 13 of 2002)

Regulations

Immigration Regulations, 2014

Annexures

Annexure A: Forms

Form 19 (DHA-46)

 

(DHA-46) Form 19

 

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DECLARATION OF FOREIGNER AS UNDESIRABLE PERSON

 

[Section 7(1)(g) read with section 30(1); Regulations 27(1) and 39(1)

 

To: ...........................................................................................

Passport No: ............................................................................

 

In terms of section 30(1) of the Act, you are hereby declared an undesirable person in the Republic due to the following reason(s):

 

*(a) You are or are likely to become a public charge;
*(b) You have been identified as such by the Minister;
*(c) You have judicially been declared incompetent;
*(d) You are an unrehabilitated insolvent;
*(e) You have been ordered to depart in terms of the Act;
*(f) You are a fugitive from justice;
*(g) You have previous criminal convictions without the option of a fine for conduct which would be an offence in the Republic; or
*(h) You have overstayed by ______  days, at a time.

 

If you disagree with the aforesaid declaration, you may, in terms of section 8(4) of the Act, make written representations to the Director-General at Overstayappeals@dha.gov.za within 10 working days of receipt of this notice to review this declaration.

 

Alternatively, you may apply to the Minister Overstayappeals@dha.gov.za to waive any of the grounds of undesirability in terms of section 30(2) of the Act if you are able to show good cause.

 

 

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

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

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Director-General

Place

Date

 

 

Place: ............................................

 

 

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

 

I acknowledge receipt of the original of this notice.

 

I *wish/do not wish to make representations within 10 working days from receipt of this notice to the Director-General in terms of section 8(4) of the Act to review the declaration.

 

I understand that I am entitled to make representations to the Minister showing good cause for the Minister to waive the grounds of undesirability in terms of section 30(2) of the Act.

 

 

............................................................................ .......................................
Signature of recipient of this notice Date

 

 

 

Place: ..........................................................

 

 


Left thumbprint

 

.................................................................... ...................................
Signature of witness                                     Date

 

*Delete whichever is not applicable

 

 

CERTIFICATE BY INTERPRETER

 

I, ...........................................................................................................(name(s) and surname) of ..............................................................................................................................................(*business/residential address) and telephone number ........................................and cell phone number ................................................hereby confirm that I have mastered .......................................................................................... (state language) and that I have explained to ................................................................................................................ (name(s) and surname of foreigner) the contents of this notice in the said language and that I am satisfied that the said foreigner fully understands it.

 

 

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

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Signature of Interpreter

Place

Date

 

[Form 19 substituted by regulation 11 of Notice No. R. 1328, GG 42071, dated 29 November 2018]