Regulations > Criminal Law (Sexual Offences and Related Matters) Regulations > Annexures > Annexure A : Forms: Services for victims of sexual offences and compulsory HIV testing of alleged sex offenders > Part I of Regulations: Services for Victims of Sexual Offences and Compulsory HIV Testing of Alleged Offenders > Form 5 : Application for HIV testing of alleged offender by investigating officer

FORM 5

[Regulation 6(1)]

APPLICATION FOR HIV TESTING OF ALLEGED OFFENDER BY INVESTIGATING OFFICER

Section 32 of the Criminal Law (Sexual Offences and Related Matters) Amendment Act, 2007 (Act No. 32 of 2007) (the Act)

IN THE MAGISTRATE'S COURT FOR THE DISTRICT OF .................................................................

HELD AT ..................................................................................................................................

CASE NO: ...............................................................................................................................

1. APPLICATION

To the clerk of the court, .............................................

Take notice that .................................................................... (the investigating officer) makes application in terms of section 32 of the Act to this Court for an order—

(a)	that the alleged sex offender, described below, be tested for HIV; or

(b)	that the HIV test results in respect of the alleged offender, already obtained on application by a victim or interested person on behalf of a victim as contemplated in section 30 of the Act, be made available—

(i)	to ............................................................................ the investigating officer); and/or

(ii)	to .....................................................................................................................

(the prosecutor who needs to know the results for purposes of the prosecution of the matter in question or any other court proceedings, contemplated in section 32(1)(b) of the Act.)

2. PARTICULARS OF VICTIM:

Full names and surname: ............................................................................................

Any other surnames: ...................................................................................................

Date of birth: ...............................................................................................................

Age: ............................................................................................................................

Identity number/passport number: .............................................................................

3.	PARTICULARS OF ALLEGED OFFENDER CHARGED WITH COMMITTING SEXUAL OFFENCE OR OFFENCE AS DEFINED IN SECTION 27 OF THE ACT

Full names and surname: ............................................................................................

Any other surnames: ...................................................................................................

Date of birth: ...............................................................................................................

Age: ............................................................................................................................

Identity number/passport number: .............................................................................

4.	GROUNDS FOR APPLICATION

On the strength of information taken on oath or by way of solemn declaration, in which it is alleged that a sexual offence or offence as defined in section 27 of the Act was committed by the alleged offender, the application is based on the following grounds:

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

*5.	PARTICULARS OF APPLICATION ALREADY BROUGHT BY VICTIM OR INTERESTED PERSON IN TERMS OF SECTION 30 OF THE ACT

Date of application: ........................................................................................................

Magistrate's Office where application was granted: ........................................................

Where is test result kept? ...............................................................................................

* Delete if not applicable

6.	AFFIDAVIT/SOLEMN DECLARATION BY INVESTIGATING OFFICER

I , ................................................................................................... (the investigating officer) with force number ........................................................................... hereby declare that the above information is to the best of my knowledge true and correct.

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

SIGNATURE OF INVESTIGATING OFFICER

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

DATE

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

PLACE

(To be completed by a Justice of the Peace/Commissioner of Oaths)

I hereby certify that before administering the *oath/taking the affirmation I asked the deponent the following questions and noted *his/her answers in *his/her 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 hereby certify that the deponent has acknowledged that *he/she knows and understands the contents of this declaration which was sworn to/affirmed before me, and the deponent's signature was placed thereafter in my presence.

Dated at.. ............................................ this .............. day of .................................... 20 .................

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

SIGNED: Justice of the Peace/Commissioner of Oaths

Full names: ...................................................................................................................................

Designation: .................................................................................................................................

Area for which appointed: .............................................................................................................

Business address: ..........................................................................................................................

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

*Delete whichever is not applicable