Annexure B

Unique reference Number ________________________

ACKNOWLEDGEMENT OF RECEIPT IN TERMS OF SECTION 34(3)(a) OF THE PREVENTION

AND COMBATING OF CORRUPT ACTIVITIES ACT, 2004 (ACT NO. 12 OF 2004)

I, ________________________________________________________

(Full Names and Surname)

stationed at ___________________________________________

Tel. No ___________________Cellular No __________________

Email Address__________________________________________

acknowledge receipt from

________________________________________________________________________________

(Full Names and Surname of person making the report)

The following documentation was received with the report:

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Signed at ______________________on this __________day of ______________________20___

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SIGNATURE OF THE DESIGNATED MEMBER

DIRECTORATE FOR PRIORITY CRIME INVESTIGATION (DPCI)