Protection from Harassment Act, 2010 (Act No. 17 of 2010)

Regulations

Protection from Harassment Regulations, 2013

Annexures

Form 13 [Regulation 15]
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APPLICATION BY STATION COMMANDER FOR EXTENSION OF PERIOD

WITHIN WHICH INFORMATION MUST BE PROVIDED TO COURT OR

CANCELLATION OF DIRECTION

SECTION 5(3)(b) OF THE PROTECTION FROM HARASSMENT ACT, 2011 (ACT NO. 17 OF 2011)

 

Note: If this application is, in terms of regulation 15(2)(a) of the Protection from Harassment Regulations, 2013, filed with the clerk of the court it must be completed in duplicate and submitted in duplicate to the clerk of the court

 

* Mark with a cross whichever is applicable

 

Application No. ............................/.....................................

DIRECTION  NO ................................................./20............................

 

 

To: ......................................................................................................................................................................................................................................................................................................

(The clerk of the court)

 

Facsimile number of clerk of the court:..............................................

 

From: ...............................................................................................................................................................................................................................................................(*station commander/ *designated member of the South African Police Service of the...........................................................................................................................................................................police station)

 

Facsimile number of station commander: ............................................................................................................................................................................................................................................

E-mail address of station commander: .............................................................................................................................................................................................................

Phone number of station commander: ............................................................................................................................................................................................................

 

 

AFFIDAVIT NO: .........................................../20...............

 

To be completed by station commander:

 

1. I hereby apply for—

(a)

an extension of the time period within which the affidavit must, in terms of section 5(3) (a) of the Protection from Harassment Act, 2011, be submitted to court

*

(b)

the cancellation of the direction on the grounds that, after a reasonable investigation of the matter, the South African Police Service is not in a position to determine the name and address of the respondent or obtain any other information which is required in order to identify or trace the respondent

*

 

2. I, ................................................................... (name, surname and Persal number), the station commander of the ........................................ police station, in support of this application hereby states as follows:

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

 

______________________________________________

____________________________________

Signature of Deponent

DATE

 

 

I certify that before administering the *oath / taking the affirmation I asked the Deponent the following questions and noted *her/his answers in *her/his 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 prescribed oath?

Answer_________________________________________________________

(c) Do you consider the prescribed oath to be binding on your conscience?

Answer_________________________________________________________

I certify that the Deponent has acknowledged that *she/he knows and understands the contents of this declaration which was *sworn to / affirmed before me, and the Deponent' s

signature was placed thereon in my presence.

 

 

 

Dated at __________________________________________________this ________________________________day of___________________________________________ 20___________

 

_____________________________________________

Justice of the Peace / Commissioner of Oaths

 

Full Names:__________________________________________________________________________________________________________________________________________________

Designation:_________________________________________________________________________________________________________________________________________________

Area for which appointed:_____________________________________________________________________________________________________________________________________

Business Address:____________________________________________________________________________________________________________________________________________

 

*To be completed by the clerk of the court on receipt of the affidavit filed in terms of regulation 15(2)(a) of the Protection from Harassment Regulations, 2013:

I, ............................................................................. (name  of clerk of the court), hereby certify that I have received this affidavit from .................................................................(name of person who furnished affidavit to clerk of the court) on ................................. (date).

 

 

_______________________________

Signature of clerk of the court

 

 

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