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

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

In the matter between

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

and

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

I, ................................................................., of .............................................................................................................................................. (address), declare on oath as follows:

(a)        I am the plaintiff in this action (or the facts herein stated are within my own knowledge and I am duly authorised to make this affidavit).

(b)        The defendant is indebted to me/to the plaintiff in the sum of R................. on the grounds stated in the summons.

(c)        I verily believe that the defendant has not a bona fide defence to the claim and that appearance has been entered solely for purposes of delay.

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

Signature

The deponent has acknowledged that he/she knows and understands the contents of this affidavit.

Signed and sworn to before me at .............................. on this ......................... day of ..............................., 20.......

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

Commissioner of Oaths

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

Area

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

Office held if appointment is held ex officio.