Prevention and Combating of Corrupt Activities Act, 2004 (Act No. 12 of 2004)

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Annexure A : Taking Down of Report

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Annexure A

TAKING DOWN OF REPORT CONTEMPLATED IN SECTION 34(3)(a) OF THE

PREVENTION AND COMBATING OF CORRUPT ACTIVITIES ACT, 2004

TO: CENTRAL REPORTING OFFICE: DIRECTORATE FOR PRIORITY CRIME INVESTIGATION

(DPCI)

I, ________________________________________________________

(Full Names and Surname)

Rank

________________________________

PERSAL

Number

stationed at ___________________________________________

Tel. No ___________________Cellular No __________________

Email Address__________________________________________

a designated member of the Directorate for Priority Crime Investigation (DPCI) in the South African Police Service have received the following report (report attached where applicable) from a person holding a position of authority as contemplated in section 34(4) of the Act,

________________________________________________________________________________

(Full Names and Surname of person making the report)

ID. No

with the following contact particulars:

Residential ___________________________________________________ (Address)

Address

___________________________________________________ (Suburb)

___________________________________________________ (Town/City)

___________________________________________________ (Country)

Tel.No (Private)________________________Cellular No _________________________

Email (Private)

____________________________________________________________

__________________________________________________________________________

Work Address

___________________________________________________ (Employer)

___________________________________________________ (Address)

___________________________________________________ (Suburb)

___________________________________________________ (Town/City)

___________________________________________________ (Country)

Tel.No (Work)________________________Fax No ______________________________

Email (Private)

____________________________________________________________

Preferred Acknowledgement

of Receipt

Communication____________________________________________________________

Method(s) Contact by DPCI

____________________________________________________________

The report received entails the following:

Description of the alleged offence - Tick the applicable offence(s)			Tick
Part 1	Sec 3	General Offence of Corruption
Part 2	Sec 4	Offences in respect of Corrupt Activities relating to Public Officers
	Sec 5	Offences in respect of Corrupt Activities relating to Foreign Public Officials
	Sec 6	Offences in respect of Corrupt Activities relating to Agents
	Sec 7	Offences in respect of Corrupt Activities relating to members of Legislative Authority
	Sec 8	Offences in respect of Corrupt Activities relating to Judicial Officers
	Sec 9	Offences in respect of Corrupt Activities relating to members of Prosecuting Authority
Part 3	Sec 10	Offences of receiving or offering of unauthorised gratification by or to party to an employment relationship
Part 4	Sec 11	Offences in respect of Corrupt Activities relating to witnesses and evidential material during certain proceedings
	Sec 12	Offences in respect of Corrupt Activities relating to Contracts
	Sec 13	Offences in respect of Corrupt Activities relating to procuring and withdrawal of tenders
	Sec 14	Offences in respect of Corrupt Activities relating to Auctions
	Sec 15	Offences in respect of Corrupt Activities relating to Sporting Events
	Sec 16	Offences in respect of Corrupt Activities relating to Gambling Games or Games of Chance
Part 6	Sec 20	Other offences relating to corrupt activities - Accessory to or after offence as contemplated in Part 1, 2, 3 or 4. or section 21
	Sec 21	Other offences relating to corrupt activities - Attempt, conspiracy and inducing another person to commit offence in terms of this Act
Part 7	Sec 34 (1)(b)	Theft, fraud, extortion, forgery or uttering of a forged document involving an amount (1)(b) of R 100,000-00 or more

1.	Provide a brief description of the suspicion of or alleged offence(s) committed. (What, when, where, why and how). Is it still ongoing?

___________________________________________________________________

2.	How did the suspicion or knowledge of the alleged offence(s) come to your attention?

___________________________________________________________________

3.	Full Names, Identity number or Date of Birth and contact details of person(s) allegedly involved in offence(s), as well as his/her/their position held and the role that he/she/they played in the commission of such offence(s)

___________________________________________________________________

4.	What is the real or potential impact, losses or consequences of such alleged offence(s)?

___________________________________________________________________

5.	Does documentation or evidence in support of the allegations exist and where/from whom can such documentation or evidence be obtained? Indicate what information was provided with the report?

___________________________________________________________________

6.	Was the matter reported to any other person or authority and if so to whom, when and what reference number was provided?

___________________________________________________________________

7.	What is the nature and extent of the gratification or benefit involved? Any information to the reporter's knowledge about the standard of living of the person(s) allegedly involved.

___________________________________________________________________

8.	Name and contact details of possible witnesses to the alleged offence(s):

___________________________________________________________________

Signed at ______________________on this __________day of ______________________20___

___________________________________________________

SIGNATURE OF THE DESIGNATED MEMBER

DIRECTORATE FOR PRIORITY CRIME INVESTIGATION (DPCI)

Unique reporting

reference number ___________________________________________________________

To be inserted by the designated DPCI members to whom the report is made. A corresponding number must appear on the

acknowledgement of receipt (Annexure B).

Prevention and Combating of Corrupt Activities Act, 2004 (Act No. 12 of 2004)

Notices

Annexures

Annexure A : Taking Down of Report

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