Broad-Based Black Economic Empowerment Act, 2003 (Act No. 53 of 2003)

Notices

Purchase

R1228 Annex

R1228 Annex (2)

AFFIDAVIT

I the undersigned ________________________________________________________________

do hereby make oath / affirmation and declare that:

1.	I am duly authorized to depose to this affidavit on behalf of the applicant; and

2.	The particulars contained in the application form are true and correct.

SIGNED at _____________________________________on this _______ day of

________________ 2020/21

_____________________

DEPONENT

(to be signed in the presence of a Justice of the Peace or Commissioner of Oaths)

1.	I certify that before administering the oath/affirmation, I asked the deponent the following questions and wrote down his/her answers in his/her presence.

(1)	Do you know and understand the contents of the declaration?

Answer ……………………………………………………………………………………….

(2)	Do you have any objection to taking the prescribed oath/affirmation?

Answer ……………………………………………………………………………………...

(3)	Do you consider the prescribed oath/affirmation to be binding on your conscience?

Answer……………………………………………………………………………….........

2.	I certify that the deponent has acknowledged that he/she knows and understands the contents of this declaration. The deponent utters the following words: “I swear that the contents of this declaration are true so help me God” / “I truly affirm that the contents of the declaration are true.”

The signature/mark of the deponent is affixed to the declaration in my presence………………………

JUSTICE OF THE PEACE

COMMISSIONER OF OATHS

TO BE COMPLETED BY THE JUSTICE OF THE PEACE/COMMISSIONER OF OATHS:

FULL FIRST NAMES AND SURNAME (BLOCK LETTERS)	_________________________
DESIGNATION:	_________________________
PHYSICAL ADDRESS:	_________________________
DATE:	_________________________
PLACE:	_________________________

PLEASE COMPLETE THE ABOVE AFFIDAVIT WHICH IS AN INSEPARABLE PART OF THE APPLICATION FORM