Regulations > [Repealed] Regulations Issued in terms of Section 27(2) of the Disaster Management Act, 2002 > Annexures > Annexure C - Forms > Form 3-Sworn Affidavit by person who wishes to attend a funeral in another Metropolitan area, District or Province (Regulation 11B(8)(d))

ANNEXURE C

FORM 3

SWORN AFFIDAVIT BY PERSON WHO WISHES TO ATTEND A FUNERAL IN ANOTHER METROPOLITAN AREA, DISTRICT OR PROVINCE

Regulation 11B(8)(d)

Note:

1.	A person giving false information on this affidavit shall be guilty of an offence and, on conviction, liable to a fine or to imprisonment for a period not exceeding six months or to both such fine and imprisonment.

2.	This affidavit may only be sworn to or affirmed at a magistrate's court or police station.

Full Names:
Surname:
Identity number:
Address of place of residence:
Province of residence:
Contact details:	Cell nr.	Tel No (h)	Email Address

Metropolitan area/district of funeral/cremation:
Province in which funeral/cremation will take place:

Hereby declare under oath with regards to the deceased:

Names of deceased:
Surname of deceased:
Relationship/Affiliation to the deceased (eg spouse/parent/friend etc)
I am the person making the funeral arrangements/applies for the issue of a death certificate (mark with an X):	YES	NO
Date of funeral/cremation
Province in which funeral/cremation will take place
*City/town/village of funeral:

*OATH/AFFIRMATION

I,_____________________________________(full names), identity number

_______________________________________, hereby declare under *oath/affirmation that the above-mentioned information is true and correct.

Signed at ___________ on this the _____________ day of____________________2020

_____________________________

Signature of person making affidavit

CERTIFICATION

I hereby certify that before administering the *oath/taking the affirmation, I asked the sheriff(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 *oath/affirmation?

Answer: ___________________

(c)	Do you consider the *oath/affirmation to be binding on your conscience?

Answer: ___________________

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

Signed at___________________this________day of______________2020.

_______________________________________

*Justice of the Peace/Commissioner of Oaths

Full names: ________________________________________________________

Designation: ________________________________________________________

Business address: __________________________________________________

__________________________________________________

*Delete which is not applicable

[Annexure C, Form 3 substituted by section 15 of Notice No. R. 465, GG43232, dated 16 April 2020]

[Annexure C, Form 3 inserted by section 8 of Notice No. R.446, GG43199, dated 2 April 2020]

Disaster Management Act, 2002 (Act No. 57 of 2002)

Regulations

Regulations Issued in terms of Section 27(2) of the Disaster Management Act, 2002

Annexures

Annexure C - Forms

Form 3-Sworn Affidavit by person who wishes to attend a funeral in another Metropolitan area, District or Province (Regulation 11B(8)(d))