Immigration Act, 2002 (Act No. 13 of 2002)RegulationsImmigration Regulations, 2014AnnexuresAnnexure A: FormsForm 19 (DHA-46) |
(DHA-46) Form 19
DECLARATION OF FOREIGNER AS UNDESIRABLE PERSON
[Section 7(1)(g) read with section 30(1); Regulations 27(1) and 39(1)
To: ...........................................................................................
Passport No: ............................................................................
In terms of section 30(1) of the Act, you are hereby declared an undesirable person in the Republic due to the following reason(s):
| *(a) | You are or are likely to become a public charge; |
| *(b) | You have been identified as such by the Minister; |
| *(c) | You have judicially been declared incompetent; |
| *(d) | You are an unrehabilitated insolvent; |
| *(e) | You have been ordered to depart in terms of the Act; |
| *(f) | You are a fugitive from justice; |
| *(g) | You have previous criminal convictions without the option of a fine for conduct which would be an offence in the Republic; or |
| *(h) | You have overstayed by ______ days, at a time. |
If you disagree with the aforesaid declaration, you may, in terms of section 8(4) of the Act, make written representations to the Director-General at [email protected] within 10 working days of receipt of this notice to review this declaration.
Alternatively, you may apply to the Minister [email protected] to waive any of the grounds of undesirability in terms of section 30(2) of the Act if you are able to show good cause.
............................................... |
..................................... |
.................... |
Director-General |
Place |
Date |
Place: ............................................
IMMIGRATION OFFICER'S PARTICULARS
Name and Surname: ............................................................................................................................
Appointment number: ........................................................................................................................
Rank/position .....................................................................................................................................
Office: ....................................................... Province: ..........................................................................
SUPERVISOR'S PARTICULARS
Name and Surname: ............................................................................................................................
Rank/position......................................................................................................................................
Contact No.: Tel: ..................................................................................................................................
ACKNOWLEDGEMENT OF RECEIPT
I acknowledge receipt of the original of this notice.
I *wish/do not wish to make representations within 10 working days from receipt of this notice to the Director-General in terms of section 8(4) of the Act to review the declaration.
I understand that I am entitled to make representations to the Minister showing good cause for the Minister to waive the grounds of undesirability in terms of section 30(2) of the Act.
| ............................................................................ | ....................................... |
| Signature of recipient of this notice | Date |
Place: ..........................................................
|
Left thumbprint |
| .................................................................... | ................................... |
| Signature of witness | Date |
*Delete whichever is not applicable
CERTIFICATE BY INTERPRETER
I, ...........................................................................................................(name(s) and surname) of ..............................................................................................................................................(*business/residential address) and telephone number ........................................and cell phone number ................................................hereby confirm that I have mastered .......................................................................................... (state language) and that I have explained to ................................................................................................................ (name(s) and surname of foreigner) the contents of this notice in the said language and that I am satisfied that the said foreigner fully understands it.
............................................... |
..................................... |
.................... |
Signature of Interpreter |
Place |
Date |
[Form 19 substituted by regulation 11 of Notice No. R. 1328, GG 42071, dated 29 November 2018]