Regulations > Disclosure of Registrable Interests > Annexures > Annexure B

Annexure B

Form 1

Regulations Relating to the Judicial Service Commission Act, 1994

Disclosure of Registrable Interests

[Regulation 3]

File number :.......................

Please note:

1.	This form must be completed in block letters.

2.	Failure to comply with any provision in Regulation 3, or the disclosure of false or misleading information, may result in the lodging of a complaint contemplated in section 14 of the Act.

3.	Proof of Minister's consent, granted in terms of section 11 of the Act, must be attached, where applicable.

A.
Surname:
Full names:
Identity number
Court where serving (only in case of judge in active service [or acting]):
Postal address:
Telephone (h):	( )	Telephone (b):		( )
Cellular phone nr:
Facsimile nr:	( )
E-mail address:
Please indicate service status:	Active service		Discharged: ....... years of age

PARTICULARS OF IMMEDIATE FAMILY MEMBER(S)

(To be completed by judges in active service if disclosure is to be made. Please attach separate page if more than two family members have registrable interests.)

1. Surname:
Full names:
Identity number
Relationship to judge:

2. Surname:
Full names:
Identity number
Relationship to judge:

PARTICULARS OF INTERESTS DISCLOSED

OWNERSHIP OR CO-OWNERSHIP OF IMMOVABLE PROPERTY

(To be disclosed by judges in active service. Please indicate if disclosure is made in respect of immediate family members.)

DESCRIPTION	LOCATION	VALUE	REMARKS

(To be disclosed by all judges required to make disclosures in terms of regulation 2(1). Please indicate if disclosure is made in respect of immediate family members.)

NATURE	NOMINAL VALUE	COMPANY/ENTITY	REMARKS

DIRECTORSHIPS, BUSINESS OR FINANCIAL INTERESTS IN ANY BUSINESS ENTERPRISE OR ANY LEGAL ENTITY

(To be disclosed by all judges required to make disclosures in terms of regulation 2(1). Please indicate if disclosure is made in respect of immediate family members.)

NAME OF ENTITY	TYPE OF BUSINESS	INCOME/BENEFIT DERIVED	REMARKS

ROYALTIES, INCOME OR OTHER BENEFITS DERIVED FROM THE APPLICATION OF SECTION 11 OF ACT 9 OF 1994

((To be disclosed by all judges required to make disclosures in terms of regulation 2(1).)

NATURE OF BENEFIT	VALUE	PARTICULARS OF MINISTERIAL CONSENT	REMARKS

SPONSORSHIPS

(Only in respect of immediate family members, if applicable, by judges in active service.)

SOURCE OF SPONSORSHIP	NATURE OF SPONSORSHIP	NOMINAL VALUE	REMARKS

GIFTS AND HOSPITALITY

(To be disclosed by judges required to make disclosures in terms of regulation 2(1). Please indicate if disclosure is made in respect of immediate family members.)

SOURCE OF GIFT/HOSPITALITY	DESCRIPTION OF GIFT/HOSPITALITY	NOMINAL VALUE	REMARKS

ANY OTHER FINANCIAL INCOME NOT DERIVED FROM HOLDING JUDICIAL OFFICE

(To be disclosed by all judges required to make disclosures in terms of regulation 2(1).)

SOURCE OF INCOME	NATURE OF INCOME	NOMINAL VALUE	REMARKS

I, the undersigned ................................ (name of judge) hereby certify that the above information is complete and correct to the best of my knowledge.

Signed at .............................. this ............ day of .......................... 20.......

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

Signature of judge

Judicial Service Commission Act, 1994 (Act No. 9 of 1994)

Regulations

Disclosure of Registrable Interests

Annexures

Annexure B

Form 1