Acts Online
GT Shield

Immigration Act, 2002 (Act No. 13 of 2002)

Regulations

Immigration Regulations, 2014

Annexures

Annexure A: Forms

Form 12 (DHA-1712A) Part B

 

(DHA-1712A) Form 12

 

Dept of Home Affairs Icon

 

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 B

 

TO BE COMPLETED IN ORDER TO DEMONSTRATE THAT THE SPOUSAL RELATIONSHIP CONTINUES TO EXIST TWO YEARS AFTER THE ISSUANCE OF THE VISA OR PERMIT

 

Particulars of citizen / permanent resident / foreigner*

 

Surname: ...........................................................

Gender:

 

First name(s): ..................................................................................................................

Residential address: .........................................................................................................

.........................................................................................................................................

..........................................................................................................................................

Identity No.

 












Or:

Passport No.: ........................................................ Nationality: .................................................

Date of birth: ..............................................................................................

Date of first entry into the Republic: ................................Type of permit: .................................

Date of expiry of permit: .................................................

 

 

Particulars of foreigner

 

 

Surname: ..................................................................

 

Gender:

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, ................................................................................................................(name and surname) being an *unmarried/divorced/widowed person and ............................................................................(name and surname) being an *unmarried/divorced/widowed person do hereby *make oath and say/hereby solemnly affirm that on ...................................................................... (date) we deposed to an affidavit confirming that we are parties to a spousal relationship. We are not married and the spousal relationship mentioned in the preceding paragraph still subsists with all the characteristics mentioned in Part A of this Form.

 

We are the parents of the following children:

 

Name of child

Date of birth

Name of mother of child

Name of father of child








 

 

....................................................... ..................................................
Signature of spouse                                                             Signature of spouse

 

 

Thus signed and *sworn/solemnly affirmed before me on this ......... day of ...................................

20 ....................................

 

 

..............................................................

Commissioner of Oaths

OFFICE STAMP

First name(s): ......................................................................................

Surname: .............................................................................................

Capacity:..............................................................................................

 

Place: ...................................................................................................

 

*Delete which is not applicable