Protection from Harassment Act, 2010 (Act No. 17 of 2010)RegulationsProtection from Harassment Regulations, 2013AnnexuresForm 9 [Regulation 10(4)] |
AFFIDAVIT BY ELECTRONIC COMMUNICATIONS SERVICE
PROVIDER TO FURNISH ADDITIONAL EVIDENCE TO COURT
SECTION 4(4)(b) OF THE PROTECTION FROM HARASSMENT ACT, 2011 (ACT NO. 17 OF 2011)
(CONFIDENTIAL)
APPLICATION NO ............/20.......
DIRECTION NO ............./20......
To: ............................................................................................................................................. (name and surname of clerk of the court identified in the direction)
Facsimile number: ......................................................................
From: .........................................................................................................................................(name and surname of designated person) of ....................................................................................................................................................(name of electronic communications service provider)
E-mail address:...............................................................................................................................................................
Facsimile number:..........................................................................................................................................................
Telephone number:........................................................................................................................................................
AFFIDAVIT NO: ............................................../20.......
I, .................................................................................................................................................................................................................... (name, surname and identity number) working as a.....................................................................................................................................................................................(designation) at............................................................................................................................................................................................ (name of electronic communications service provider) situated at the following address............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................., hereby states as follows in response to the request for further evidence:...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................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______________________________________________ |
____________________________________ |
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:___________________________________________________________________________________________________________________________________________
(CONFIDENTIAL)
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