(DHA-1567) Form 40

LIST OF STOWAWAYS

[Section 7(1)(g) read with section 35(5)(b); Regulation 33(10)]

The person in charge of a conveyance entering a port of entry in the Republic shall, on demand, deliver to the immigration officer a list of stowaways.

PART A

STOWAWAYS

Details of Conveyance

Name of conveyance: .....................................................................................................................................................................................

Registration No: .............................................................................................................................................................................................

Name(s) and surname of person in charge of conveyance: ..............................................................................................................................

Port of entry: .................................................................................................................................................................................................

Date of entry: ................................................................................................................................................................................................

PERSONAL PARTICULARS OF STOWAWAYS

PART B

DETAILS OF STOWAWAY

(To be completed in respect of each stowaway)

Nationality.......................................................................                                                                 Country of origin ...........................................................................................................................

First language: ..................................................................                                                                Other spoken languages: ...............................................................................................................

Passport/travel document No.: .........................................                                                                Date of issue .................................................................................................................................

Place of issue: ...................................................................                                                               Date of expiry: ..............................................................................................................................

Issuing authority: ...................................................................................................................................................................................................................................................................

Home address/Address in country of boarding .......................................................................................................................................................................................................................

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

Employer's name: ..................................................................................................................................................................................................................................................................

Employer's address: ...............................................................................................................................................................................................................................................................

Height: ..................................................... Weight: .....................................................         Marital status: .............................................................................................................................

Name(s) and surname of spouse: ...........................................................................................................................................................................................................................................

Nationality of spouse: .................................................................................................        Address of spouse: .......................................................................................................................

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

Names and surname of parents: .............................................................................................................................................................................................................................................

Nationality of parents: ...........................................................................................................................................................................................................................................................

Address of parents: ................................................................................................................................................................................................................................................................

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

STOWAWAY DETAILS

Date found: ......................../........................./............................                         Time found: ....................................................................................................................................................

Place of boarding ....................................................................................        Country of boarding ........................................................................................................................................

Time spent in country of boarding: .....................................................               Intended port of destination: .........................................................................................................................

Intended final destination (if different): ..............................................................................................................................................................................................................................

Stated reasons for boarding the ship ....................................................................................................................................................................................................................................

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

OTHER DETAILS

Method of boarding, including other persons involved (e.g. crew, port workers etc.), and whether they were secreted in cargo/container or hidden in the vessel:

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

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Inventory of stowaway's possessions:

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

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

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

Was the stowaway assisted in boarding the vessel, or assisted by any member of the crew?

If so, was any payment made for the assistance? .................................................................................................................................................................................................................

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

Statement made by the stowaway (attach additional page, if space is not enough):

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

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

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Statement made by the person in charge of the conveyance (Master), including any observations on the credibility of the information provided by the stowaway:

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

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

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

I hereby certify that this list contains the particulars of all stowaways found on board my conveyance.

Date of interview of the stowaway: ............................................................                                      Place: ........................................................................

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

Signature of stowaway                                                          Place                                                                                              Date

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

Person in charge of conveyance                                       Place                                                                                                 Date

ACKNOWLEDGEMENT OF RECEIPT

I, ...............................................................................................................................................................(name of immigration officer) hereby confirm receipt of the list of stowaways in terms of section 35(5)(b) of the Act.

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Signature of immigration officer                                        Place                                                                                                        Date