In the Magistrate's Court for the District/Region of .......................................................held at ................................................. Case No. ........................................ of 20.........

In the matter between

..................................................................................................................... Judgment Creditor

and

................................................................................................................. Judgment Debtor

Whereas the said ................................. on the .............................. day of .........................., 20...... obtained judgment in this court against the said ......................... for the sum of R............ together with a sum of R............. for costs;

And whereas the said court, notwithstanding that the said ..................................... has noted an appeal against the judgment, has directed the judgment to be carried into execution upon security being given for restitution;

Now, therefore, the said ................................. and .................................. of ................................. as surety and co-principal debtor for the said .............................. hereby bind themselves jointly and severally to refund the above sums of R.......... and R.......... should the judgment of the said court be reversed and further severally .......................................... (insert any further terms required).

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

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

Judgment Debtor

Witnesses:

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

Signature and address

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

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

Surety and co-principal debtor

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

Signature and address

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