FORM 7B

APPLICATION ON BEHALF OF ANOTHER PERSON

SECTION 32(1)(b) OF THE PREVENTION OF AND TREATMENT FOR SUBSTANCE ABUSE ACT, 2008 (ACT NO. 70 OF 2008)

(Regulation 48)

I, ___________________________________________________________________    names),

Identity number:                                                                                                                             residing at

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hereby give consent to be admitted to treatment centre/mentioned below and also appoint:

to facilitate the admission on my behalf—

                                                                (name of the treatment centre)

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                                                          (physical address of the treatment centre)

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                                                     Signature of person acting on behalf of service user

SIGNED BEFORE ME after I have explained to the said parent or person acting on behalf of service user as set out in section 32(1) of the Act, and have informed *him/her that—

PLACE: ________________________________________________

DATE: _________________________________________________