In the district/regional court...................................... held at................................................

                                                                                                                                                                                             Case No.................................

THE STATE

vs.........................................................................................................................................

TO THE DIRECTOR OF PUBLIC PROSECUTIONS OR PERSON DESIGNATED BY HIM OR HER (OR OTHER PROSECUTOR*).............. ...................................................................................................

AND TO THE APPELANT, .........................................................................

TAKE NOTICE THAT the application by the appellant for leave to appeal in terms of section 309B of the Criminal Procedure Act, 1977 (Act No. 51 of 1977), has been set down for hearing on ............................ (date), at ........................(time) or so soon thereafter as the matter may be heard, in Court No.

………...................................., Magistrate’s Office

…………………………............………

REGISTRAR/CLERK OF THE COURT, ..................................................................................................

TO THE DIRECTOR OF PUBLIC PROSECUTIONS OR PERSON DESIGNATED BY HIM OR HER,........................................................................

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

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

(Address)

TO THE PROSECUTOR*, .......................................................................................................................................................................

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

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

(Address)

TO THE APPELLANT, ..........................................................................................................................................................................

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

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

(Address)

OR TO, ......................................................................................................................................

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

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

(Address of appellant’s legal representative, if any)

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE IN TERMS OF SECTION 309B (2)(d) OF THE CRIMINAL PROCEDURE ACT, 1977

Receipt of the above-mentioned notice is hereby acknowledged.

FOR DIRECTOR OF PUBLIC PROSECUTIONS OR PERSON DESIGNATED BY HIM OR HER...................(Signature)

.....................................................................................................................(Name in print)

FOR OTHER PROSECUTOR ............................................................................. (Signature)*

.....................................................................................................................(Name in print)

FOR APPELLANT............................................................................................(Signature)

.....................................................................................................................(Name in print)

* Only to be completed in a case in which the prosecution was not at the public instance.