In the Magistrate's Court for the District/Region of ...................................................................................

held at ......................................... Case No. ........................................ of 20.........

In the matter between

..................................................................................................................... Applicant

and

................................................................................................................. Respondent

Whereas ....................................... of ..................................... has applied for the issue of a warrant for the arrest of ........................... of ........................... (or for an order for the attachment of or interdict against the goods of ........................... at ...........................) and the court has fixed the security to be given by the said ............................... in the sum of R...........;

Now, therefore, the said ........................................ binds himself or herself to satisfy any lawful claim by the said ............................... against the said .............................. for damages which the said ............................. may suffer by reason of the said arrest/attachment/interdict in case the said arrest/attachment/interdict be hereafter set aside;

And ................................. of ................................. hereby binds himself or herself as surety for and co-principal debtor with the said ......................... in a sum not exceeding the said sum of R......for the due fulfilment by the said ......................... of the obligation hereby undertaken by him or her.

Signed at ....................................... this ......................... day of ............................., 20....

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

Applicant.

Witnesses:

1.        ................................................................

      Signature and address

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

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

Surety and co-principal debtor

2.         ................................................................

Signature and address

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