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 6 : Sworn affidavit by person who intends to travel to or from another province during Adjusted Alert Level 4 |
FORM 6
SWORN AFFIDAVIT BY PERSON WHO INTENDS TO TRAVEL TO AND FROM ANOTHER PROVINCE DURING ADJUSTED ALERT LEVEL 4
Note: This affidavit may only be sworn to or affirmed at a magistrate's court or police station.
I,
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) |
e-mail address |
(Please indicate with an "X")
Hereby declare under oath that I am—
moving to a new place of residence; |
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caring for an immediate family member; |
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obtaining medical treatment; |
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returning to their place of residence from a quarantine or isolation facility; and |
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transiting through Gauteng. |
that requires travel across Provinces during Adjusted Alert Level 4.
*OATH/AFFIRMATION
I,_____________________________________(full names), identity number _______________________________________, hereby declare under *oath/affirmation that the above-mentioned information is true and correct.
Signed at ___________ on this the _____________ day of ____________________ 20 ____ .
_____________________________
Signature of deponent
CERTIFICATION
I hereby certify that before administering the *oath/taking the affirmation, I asked the deponent the following questions and noted *his/her answers in *his/her 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 *oath/affirmation? |
Answer: ___________________
(c) | Do you consider the *oath/affirmation to be binding on your conscience? |
Answer: ___________________
I hereby certify that the deponent has acknowledged that *he/she knows and understands the content of this declaration which was *sworn to/affirmed before me, and the deponent's signature was placed thereon in my presence.
Signed at ___________________ on this ________ day of ______________ 20 _____.
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*Justice of the Peace/Commissioner of Oaths
[Form 6 substituted by section 8 of Notice No. R. 610, GG44838, dated 11 July 2021]