Social Assistance Act, 2004 (Act No. 13 of 2004)

Regulations

Regulations relating to the Lodging and Consideration of Applications for Reconsideration of Social Assistance Application by the Agency and Social Assistance Appeals by the Independent Tribunal

Annexure A : Consolidated Forms

Form 4 : Application for Condonation for Late Appeal
Purchase cart Previous page Return to chapter overview Next page

 

FORM 4

 

APPLICATION FOR CONDONATION FOR LATE APPEAL

(Regulation 15)

[Section 18(1A) of the Social Assistance Act 13 of 2004]

 

A.        PERSONAL DETAILS OF APPLICANT OR BENEFICIARY

Surname:

Full Names:

ID Number:

Nationality:

Date of Birth:

Gender:       M

F

Tel No:

Fax No:

Email:

Cell No:

Physical Address

Postal Address

 

B.        REASONS FOR LATE LODGING OF AN APPEAL

 

Reasons for application for condonation as contemplated in regulation 15(2):

 

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

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

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

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

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

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

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

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

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

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

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

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

(If the space provided is insufficient, please attach a separate page to this form and clearly indicate that a separate page(s) is attached).

 

C.DOCUMENTATION TO ACCOMPANY CONDONATION APPLICATION

 

FORM 3 (Application for Appeal)

All documents required under Form 3

 

 

 

 

 

 

 

Signature of applicant/beneficiary/representative

 

Place

 

Date