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Protection from Harassment Act, 2010 (Act No. 17 of 2010)

Regulations

Regulations in terms of the Protection from Harassment Act 2011

Annexure : Form 26 [Regulation 29]

 

 

STATEMENT TO BE COMPLETED BY PERSON WHO SERVES, FILES OR

FORWARDS DOCUMENT BY FACSIMILE

 

 

APPLICATION NO ................................../............................................................

DIRECTION NO:.............................................................................................................................................................................................................................

 

(a)        Date on which document was sent by facsimile ................................................................................................................................................................

(b)        Time of sending facsimile ................................................................................................................................................................................................

(c)        Facsimile number from which facsimile was sent .............................................................................................................................................................

(d)        Person/organisation to which facsimile was addressed ....................................................................................................................................................

 

 

I, .............................................................................................................................................................................................(name and surname) ......................... (identity number) employed as a ............................................................................................................................................................................................................................................................................................................................................................designation) at ........................................................................................................................................................ (employer) situated at the following address:

......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................., hereby declares as follows:

 

(a) I have sent the following document ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... (description of the document) with the following reference number ...................................................... and which is dated .................................................................................,to the following facsimile number ..........................................................................................................................................................................

 

(b) Subsequent to the sending of the above facsimile I -

(i) obtained the attached transmission verification report as to whether the document was successfully transmitted to the facsimile number of the person/organisation; and

(ii) telephonically confirmed with a person who identified himself/herself as....................................................... (name and surname) who is employed at.....................................................................................................................................................as a ......................................................................(designation) with the following identity number ..................................................................................................................................................., that the facsimile was received by him or her.

 

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

 

Signature of person: ...................................................................................

 

Take note: In terms of regulation 29(3) of the Protection from Harassment Regulations, 2013, the document/s served, filed or forwarded in terms of regulation 29(1), the transmission verification report in terms of regulation 29(2)(a) and this statement must be kept as proof of service, filing or delivery.

 


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