Statistics Act, 1999
R 385
Immigration Act, 2002 (Act No. 13 of 2002)RegulationsImmigration Regulations, 2014AnnexuresAnnexure A: FormsForm 12 (DHA-1712A) |
(DHA-1712A) Form 12
AFFIDAVIT IN RESPECT OF PARTIES TO PERMANENT HOMOSEXUAL OR
HETEROSEXUAL RELATIONSHIP
[Section 7(1)(g), read with sections 11(6) and 26(b); Regulations 3(2) and (4)]
PART A
TO BE COMPLETED IN THE CASE OF INITIAL APPLICATION:
Particulars of citizen / permanent resident / foreigner*
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Surname: .......................................................................... |
Gender: |
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First name(s): ............................................................................................................................. Residential address..................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... |
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Identity No.
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Or: Passport No.: ................................... Nationality: .................................... Date of birth: ......................... Date of first entry into the Republic: ................................... Type of permit: .................................................................. Date of expiry of permit: .............................
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Particulars of foreigner
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Surname: ...........................................................................
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Gender: |
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First name(s): ..................................................................................................................
Residential address: .......................................................................................................... .......................................................................................................................................... Passport No: ........................................Date of birth: ............................... Place of birth: ......................................................Nationality: ........................................... Date of first entry into the Republic: ........................................ Type of visa/permit held: ......................................... Date of expiry.................................... |
I, .......................................................................................................................................(first name(s) and surname) being an *unmarried/divorced/widowed person and ......................................................................................................(first name(s) and surname) being an *unmarried/divorced/widowed person do hereby *make oath and say/hereby solemnly affirm that we are parties to a *homosexual/heterosexual spousal relationship for the past ..................................................years ............................................ months which is intended to be permanent and to the exclusion of any other person from our relationship. Our relationship involves cohabitation and a reciprocal obligation to support one another emotionally and financially. Neither of us are party to a marriage or spousal relationship with any other person.
To substantiate our relationship we attach documentation proving cohabitation and the extent to which the related financial responsibilities are shared by us.
We are the parents of the following children:
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Name of child |
Date of birth |
Name of mother of child |
Name of father of child |
We agree to submit an affidavit confirming the existence of our relationship after two years from the date of issue of the visa or permit and undertake to inform the Director-General in writing as soon as our spousal relationship cease to exist
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| Signature of citizen/permanent resident | Signature of foreign spouse or foreigner |
Thus signed and *sworn/solemnly affirmed before me on this ...................... day of ......................................................20 ......
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Commissioner of Oaths |
OFFICE STAMP |
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First name(s): ..................................................................................... |
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Surname: ........................................................................................... |
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Capacity:............................................................................................ |
Place: .................................................................................................
*Delete which is not applicable
