I,                                                                                  [fill in name of Director-General or person signing certificate on his or her behalf]  the undersigned, acting in my capacity as Director-General/duly designated officer [delete whichever is not applicable] of the Department of Land Affairs, hereby certify, in terms of section 1(2)(a) of the Extension of Security of Tenure Act, 1997 (Act No. 62 of 1997), that                                                                 [fill in applicant's name], in his/her capacity as __________________________________________ [fill in applicant's designation], is authorised to act as owner/person in charge [delete whichever is not applicable] for all purposes contemplated in that Act, of the land described as:

[Give the full Deeds Office description of the land concerned if any. In the case of a farm, this must include the portion, name and number of the farm, and the name of the district in which the farm is situated.]

This certificate is issued subject to the following conditions:

[Set out the conditions to which the authority to act as owner or person in charge is subject.]

Signed at                                                     [name of town or city] on this                       day of                                            

[Signature and full name of the person signing this certificate]

[Designation]

Contact person                                                                                                                

Contact tel. no.                                                                                                                

Address: