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

Regulations

Regulations issued in terms of Section 27(2) of the Disaster Management Act, 2002 (COVID-19)

Annexures

Annexure A : Forms

Form 6 : Sworn affidavit by person who intends to travel to or from another province during Adjusted Alert Level 4
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FORM 6

SWORN AFFIDAVIT BY PERSON WHO INTENDS TO TRAVEL TO AND FROM ANOTHER PROVINCE DURING ADJUSTED ALERT LEVEL 4

 

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

 

I,

Full Names:

Surname:

Identity number:

Address of place of residence:

Province of residence:

Contact details:

Cell nr.

Tel No (h)

e-mail address



 

(Please indicate with an "X")

Hereby declare under oath that I am—

 

moving to a new place of residence;

caring for an immediate family member;

obtaining medical treatment;

returning to their place of residence from a quarantine or isolation facility; and

transiting through Gauteng.

 

that requires travel across Provinces during Adjusted Alert Level 4.

 

*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 ____________________ 20 ____ .

 

 

_____________________________

Signature of deponent

 

CERTIFICATION

 

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 *oath/affirmation?

Answer: ___________________

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

Answer: ___________________

 

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

 

 

Signed at ___________________ on this ________ day of ______________ 20 _____.

 

 

_______________________________________

*Justice of the Peace/Commissioner of Oaths

 

[Form 6 substituted by section 8 of Notice No. R. 610, GG44838, dated 11 July 2021]