(DHA-1714A) Form 2

NOTICE OF DECISION ADVERSELY AFFECTING RIGHT OF PERSON

[Section 9, read with section 8(3); Regulation 6]

*Part A:

In relation to port of entry

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

Passport No. ........................................... Visa No. (where applicable):......................................

With reference to ..................................................................................................... you are, in accordance with the provisions of section 8(3) of the Act, hereby, notified that the decision is as follows:

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The reason(s) for the decision is/are the following:

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You may, within 10 working days from date of receipt of this notice, make written representations to the Director-General through the South African Embassy in the country of your residence or citizenship to review this decision.

It is your responsibility to enquire about the outcome of your representations.

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Appointment number

IMMIGRATION OFFICER'S PARTICULARS

Name and Surname:...................................................................................................................

Appointment number:...............................................................................................................

Rank/position............................................................................................................................

Port of Entry:..............................................................................................................................

Province:.....................................................................................

ACKNOWLEDGMENT OF RECEIPT

I acknowledge receipt of the original of this notice and declare that I understand its content.

I *intend/do not intend to make representations to the Department in terms of section 8(4) of the Act to review the decision.

Written representations *are attached/will be submitted within 10 working days.

*Delete which is not applicable

CERTIFICATE BY INTERPRETER

I, .................................................................................................................................. (name(s) and surname) of ..............................................................................................................................(business name and address) and ....................................................................................................................................... (residential address) with telephone number ........................................................ and cell 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.