Protection from Harassment Act, 2011 (Act No. 17 of 2011)RegulationsProtection from Harassment Regulations, 2013AnnexuresForm 26 [Regulation 29] |
STATEMENT TO BE COMPLETED BY PERSON WHO SERVES, FILES OR
FORWARDS DOCUMENT BY FACSIMILE
APPLICATION NO ................................../............................................................
DIRECTION NO:.............................................................................................................................................................................................................................
(a) Date on which document was sent by facsimile ................................................................................................................................................................
(b) Time of sending facsimile ................................................................................................................................................................................................
(c) Facsimile number from which facsimile was sent .............................................................................................................................................................
(d) Person/organisation to which facsimile was addressed ....................................................................................................................................................
I, .............................................................................................................................................................................................(name and surname) ......................... (identity number) employed as a ............................................................................................................................................................................................................................................................................................................................................................designation) at ........................................................................................................................................................ (employer) situated at the following address: ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................., hereby declares as follows:
(a) I have sent the following document ......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... (description of the document) with the following reference number ...................................................... and which is dated .................................................................................,to the following facsimile number ..........................................................................................................................................................................
(b) Subsequent to the sending of the above facsimile I - (i) obtained the attached transmission verification report as to whether the document was successfully transmitted to the facsimile number of the person/organisation; and (ii) telephonically confirmed with a person who identified himself/herself as....................................................... (name and surname) who is employed at.....................................................................................................................................................as a ......................................................................(designation) with the following identity number ..................................................................................................................................................., that the facsimile was received by him or her.
Date: ..........................................................................................................
Signature of person: ................................................................................... |
Take note: In terms of regulation 29(3) of the Protection from Harassment Regulations, 2013, the document/s served, filed or forwarded in terms of regulation 29(1), the transmission verification report in terms of regulation 29(2)(a) and this statement must be kept as proof of service, filing or delivery.