Regulations > Immigration Regulations, 2014 > Annexures > Annexure A: Forms

(DHA-1740) Form 9

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APPLICATION FOR CHANGE OF CONDITIONS ON EXISTING VISA

OR CHANGE OF STATUS

[Section 10(6); Regulation 9(6)]

IMPORTANT

I, __________________________________________________________________ (surname and name of applicant), with passport number_________________________________ declare that I understand that—

1.	This application form and supporting documents must be submitted in person at a designated office of the Department;

Except in the case of medical treatment OR if the applicant is the spouse or dependent child of the holder of a business or work visa, the holder of a port of entry visa, visitor's visa and medical treatment visa may not apply for a change of conditions or status of an existing visa, unless he or she is in possession of a letter issued on behalf of the Minister of Home Affairs that good cause had been demonstrated for the submission of such an application;

3.	An application for change of conditions or status of an existing visa will only be accepted if the application and relevant supporting documents are submitted at least 60 days before the expiry of the existing visa; and

4.	An application for change of status does not grant me such status and does not entitle me to any benefits under the Immigration Act, including the right to sojourn in the Republic pending the decision in respect of the application.

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Signature of applicant

Date

For official use only

BLOK:

Office of application:

Date received:

Track & Trace Ref No.:

Submission quality checked by: ...................................

Persal number: ............................................................

Date: ...........................................................................

Regional file no.:

Passport checked/returned by: ....................................

Persal number: ............................................................

Date: ...........................................................................

Date received at Head Office:

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

Fee received by: ..........................................................

Persal number: ............................................................

Receipt number: ..........................................................

Date: ............................................................................

Approved/rejected by: .......................

Persal number: ..................................

Rank: ..................................................

Conditions of visa/Reason(s) for rejection: ........................................................................

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

PARTICULARS OF APPLICANT:

Surname/Family name:	First name(s):	Date of birth:
Residential address in the Republic:
Home Telephone No:
Work Telephone No.
Cellphone No.
E-mail address:

PASSPORT DETAILS:

Passport number:	Issuing country:
Date of issue:	Valid until:
If you have any other identity document issued by your government, provide details:
Type of document:	Number:
Date of issue:	Expiry date:

DETAILS OF ORIGINAL VISA ISSUED TO YOU PRIOR TO OR ON ARRIVAL IN THE REPUBLIC OF SOUTH AFRICA:

Date of entry:

Permit No:

Place of entry:

Date of expiry:

Purpose of entry:

DETAILS OF ANY SUBSEQUENT VISA ISSUED TO YOU OR THE MOST RECENT RENEWAL THEREOF:

Type of visa:
Issued at:	Reference number:
Date of issue/renewal:	Date of expiry:

I HEREBY APPLY TO:

*Delete which is not applicable

* Change the status of my existing visa. (Provide details of the type of visa you require and the reason(s)); or

* Change the conditions on my existing visa as follows. (Provide details)

Provide full details of your reason(s) for requesting the above-mentioned change of status or conditions (attach page if space is not enough):

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

SECURITY AND HEALTH QUESTIONNAIRE

Have you or any of your dependants accompanying you ever been convicted of any crime in any country?	Yes	No
Is a criminal/civil case pending against you or any of your dependants accompanying you in any country?	Yes	No
Are you or any of your dependants suffering from tuberculosis, any other infectious or contagious disease or any mental or physical deficiency?	Yes	No
Are you an unrehabilitated insolvent?	Yes	No
Have you ever been judicially declared incompetent?	Yes	No
Are you a member of or adherent to an association or organisation advocating the practice of social violence, or racial hatred?	Yes	No
Furnish full particulars if the reply to any of the above questions is in the affirmative: ............................................................................................................................................ ............................................................................................................................................ ............................................................................................................................................ ............................................................................................................................................

ADDITIONAL MATTERS YOU WISH TO BRING TO THE DEPARTMENT'S ATTENTION

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

DECLARATION BY APPLICANT

1.	I acknowledge that I understand the contents and implications of this application. I solemnly declare that the above particulars provided by me are true and correct.

2. All the documents in support of my application are attached.

Signed at......................................on this ............. of ........................................... 20...............

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Signature of applicant

Form 9 Supporting Documents

Immigration Act, 2002 (Act No. 13 of 2002)

Regulations

Immigration Regulations, 2014

Annexures

Annexure A: Forms

Form 9 (DHA-1740)