A

PARTICULARS OF REQUESTER

(This is the relative of the missing person/deceased victim who has been designated by the family of the missing person/deceased victim to request assistance on behalf of the family)

1.

Title: (Mr, Miss, Mrs, Dr)

2.

Surname:

3.

First Names:

4.

ID number/date of birth if ID number is not available: (Please attach a copy of your identity document/birth certificate)

5.

Are you a relative of the missing person or deceased victim? (Mark with "x")

Yes

No

6.

Relation to missing person or deceased victim:

7.

Contact details:

(State below the address where you live and to which mail may be sent. If you do not have an address, state the address of another person who can be contacted, e.g. place of worship, school, community leader, etc.)

Home:

Work:

Cell

no:

E-mail

Facsimile

B

PARTICULARS OF PERSON WHO COUNTERSIGNS THIS FORM

(The person countersigning this form may only do so if he or she is another relative of the missing person or deceased victim who is over the age of 21 years; or a person over the age of 21 years who knows the requester, if another relative is not available.

1.

Title: (Mr, Miss, Mrs, Dr)

2.

Surname:

3.

First Names:

4.

ID number/date of birth if ID number is not available: (Please attach a copy of your identity document/birth certificate)

5.

Are you a relative of the missing person or deceased victim? (Mark with "x")

Yes

No

6.

Relation to missing person or deceased victim:

7.

Contact details:

Home:

Work:

Cell

no:

E-mail

Facsimile

C

PARTICULARS OF MISSING PERSON/DECEASED VICTIM

(The person countersigning this form may only do so if he or she is another relative of the missing person or deceased victim who is over the age of 21 years; or a person over the age of 21 years who knows the requester, if another relative is not available.

1.

Title: (Mr, Miss, Mrs, Dr)

2.

Surname:

3.

First Names:

4.

ID number/date of birth if ID number is not available: (Please attach a copy of your identity document/birth certificate)

D

PARTICULARS OF RECIPIENTS

(Recipients are relatives of the missing person/deceased victim designated by the requester after consultation with the family and who may receive assistance to attend an exhumation procedure, cleansing ceremony and hand-over ceremony.)

The requester must indicate below the full names and id numbers of the recipients who will attend the procedure or ceremony.

Name and Surname

ID Number

1

2

3

4

5

6

7

8

9

A

EXHUMATION

a.

PARTICULARS OF EXHUMATION

1.

Date and time of exhumation:

2.

Place of exhumation

b.

TRANSPORT AND SUBSISTENCE ALLOWANCE FOR PERSON REQUESTING ASSISTANCE

(This part should be completed in respect of the requester and every other recipient by using copies of this page.)

1.

2.

Means of travel: (mark with "x")

Air

transport

Public transport

(e.g.

taxi/bus)

Private

transport

3.

Date of travel:

4.

Time of travel:

5.

Travelling from:

6.

Travelling to:

7.

Total distance to be travelled:

8.

Subsistence allowance required for how many nights?

9.

Please give reasons why accommodation is to be hired for the nights referred to in 8 above:

10.

10.

11.

Banking details of person in whose bank account the allowance is to be paid, if granted:

B

LEGAL OR FINANCIAL ASSISTANCE FOR THE PURPOSE OF AN APPLICATION FOR AN ORDER PRESUMING THE DEATH OF A MISSING PERSON

(Particulars of disappearance of person who was reported to the Truth and Reconciliation Commission as disappearing and missing and who is believed to have disappeared or who went missing during the period 1 march 1960 and 10 may 1994 as a result of the conflicts of the past)

1.

Division of High Court in which it is intended to bring an application for an order presuming the death of the person reported missing

2.

Date/approximate date person went missing:

3.

Place where person went missing/is believed to have gone missing (if known):

4.

State the circumstances under which the person went missing:

5.

Give reasons why it is believed that the person went missing as a result of conflicts of the past:

6.

Banking details of person in whose bank account the financial assistance is to be paid, if granted: (If financial assistance in respect of the application is provided, it shall be paid directly into the bank account of the person, who rendered the legal assistance):

C

ONCE-OFF GRANT FOR THE REBURIAL OF A DECEASED VICTIM

1.

Date on which deceased victim is to be/was re-buried:

2.

Banking details of person in whose bank account the once the off grant is to be paid, if granted:

D

ONCE-OFF GRANT FOR THE SYMBOLIC BURIAL OF A DECEASED VICTIM

1.

Date on which deceased victim is to be/was symbolically buried:

2.

Banking details of person in whose bank account the once off grant is to be paid, if granted:

E.

CLEANSING CEREMONY IN RESPECT OF A DECEASED VICTIM

a.

PARTICULARS OF CLEANSING CEREMONY

1.

Date and time of cleansing ceremony:

2.

Place(s) of cleansing ceremony:

b.

TRANSPORT AND SUBSISTENCE ALLOWANCE FOR PERSON REQUESTING ASSISTANCE FOR ATTENDING A CLEANSING CEREMONY IN RESPECT OF A DECEASED VICTIM

(This part should be completed in respect of the requester and every other recipient by using copies of this page.)

1.

Full names of person requesting travel and subsistence allowance:

2.

Means of travel: (mark with "x")

Air

transport

Public transport

(e.g.

taxi/bus)

Private

transport

3.

Place of killing of deceased victim:

4.

Place of burial of deceased victim:

5.

Date of travel:

6.

Time of travel:

7.

Travelling from:

8.

Travelling to:

9.

Total distance to be travelled:

10.

Subsistence allowance required for how many nights?

11.

Please give reasons why accommodation is to be hired for the nights referred to in 10 above:

12.

12.

13.

Banking details of person in whose bank account the allowance is to be paid, if granted:

F

ASSISTANCE TO PURCHASE ANIMAL FOR THE PURPOSE OF A CLEANSING CEREMONY IN RESPECT OF A DECEASED VICTIM

1.

Date on which cleansing ceremony in respect of deceased victim is to be/was performed:

2.

Banking details of person in whose bank account the allowance is to be paid, if granted:

G

HAND-OVER CEREMONY

a.

PARTICULARS OF HAND OVER CEREMONY

1.

Date and time of hand-over:

2.

Place of hand-over:

b.

TRANSPORT AND SUBSISTENCE ALLOWANCE FOR PERSON REQUESTING ASSISTANCE FOR ATTENDING A HAND-OVER CEREMONY IN RESPECT OF A DECEASED VICTIM

(This part should be completed in respect of the requester and every other recipient by using copies of this page.)

1.

Full names of person requesting travel and subsistence allowance:

2.

Means of travel: (mark with "x")

Air

transport

Public transport

(e.g.

taxi/bus)

Private

transport

3.

Date of travel:

4.

Time of travel:

5.

Travelling from:

6.

Travelling to:

7.

Total distance to be travelled:

8.

Subsistence allowance required for how many nights?

9.

Please give reasons why accommodation is to be hired for the nights referred to in 8 above:

10.

10.

11.

Banking details of person in whose bank account the money to attend a hand-over ceremony in respect of a deceased victim is to be paid, if granted: