Disaster Management Act, 2002 (Act No. 57 of 2002)RegulationsRegulations issued in terms of Section 27(2) of the Disaster Management Act, 2002 (COVID-19)AnnexuresAnnexure A : FormsForm 4 : Permit to Travel to and from Gauteng other for a Funeral |
FORM 4
PERMIT TO TRAVEL TO AND FROM GAUTENG OTHER FOR A FUNERAL
(To be completed by the head of court or a station commander or a person designated by him or her respectively.)
I,______________________________________ (full names of *head of court, or a person designated by him or her/station commander of a police station or a person designated by him or her) for—
(a) | the Magistrate's court for the district of ____________________; |
(b) | the police station at _____________________________________, |
hereby issue this permit for travel to another district/province, to the following person:
Full names |
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Surname |
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Identity number |
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Address of place of residence: |
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Province of residence: |
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Contact details |
Cell nr. |
Tel No (h) |
Email Address |
Province traveling to: |
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Date of funeral: |
I also declare that the above-mentioned person presented the *death certificate/certified copy of the death certificate/affidavit to me.
Signed at ___________ this _____________ day of____________________20____
_____________________________ |
Official stamp |
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* Person issuing permit |
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[Form 4 substituted by section 6 of Notice No. R. 565, GG44772, dated 27 June 2021]