APPLICATION BY ELECTRONIC COMMUNICATIONS SERVICE PROVIDER FOR

EXTENSION OF PERIOD WITHIN WHICH INFORMATION MUST BE PROVIDED

TO COURT OR CANCELLATION OF DIRECTION

SECTION 4(3)(b) OF THE PROTECTION FROM HARASSMENT ACT, 2011 (ACT NO. 17 OF 2011)

APPLICATION .............................../.................................

DIRECTION NO .................../20.....

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

(The clerk of the court)

Facsimile number of clerk of the court: .......................................................................................................................................

From: ........................................................................................................................................................................................................................................................................(name and surname of designated person) of ...........................................................................................................................................................................................................................................................................(name of electronic communications service provider)

E-mail address: ............................................................................................................................................................................................................................................................................

Facsimile number: ...........................................................................................................................................................................................................................................................................

Telephone number: .....................................................................................................................................................................................................................................................................

Physical address: .............................................................................................................................................................................................................................................................................

* Mark with a cross whichever is applicable

AFFIDAVIT NO .................................................................../20...........................................

To be completed by designated person of electronic communications service provider:

1. On behalf of the abovementioned electronic communications service provider, I hereby apply for—

2. I, .................................................................................................................................................................................................................... (name, surname and identity number) working as a............................................................................................................................................(designation) at............................................................................................................................................................................................................................... (name of electronic communications service provider) situated at the following address..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................., in support of the application hereby state as follows: ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

I certify that before administering the *oath / taking the affirmation I asked the Deponent the following questions and noted *her/his answers in *her/his presence as indicated below:-

(a) Do you know and understand the contents of the above declaration?

Answer________________________________________________________________

(b) Do you have any objection to taking the prescribed oath?

Answer________________________________________________________________

(c) Do you consider the prescribed oath to be binding on your conscience?

Answer________________________________________________________________

I certify that the Deponent has acknowledged that *she/he knows and understands the contents of this declaration which was *sworn to / affirmed before me, and the Deponent' s signature was placed thereon in my presence.

Dated at __________________________________________________this ________________________________day of___________________________________________ 20___________

_____________________________________________

Justice of the Peace / Commissioner of Oaths

Full Names:_________________________________________________________________________________________________________________________________________________

Designation:________________________________________________________________________________________________________________________________________________

Area for which appointed:____________________________________________________________________________________________________________________________________

Business Address:___________________________________________________________________________________________________________________________________________

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