Promotion of National Unity and Reconciliation Act, 1995 (Act No. 34 of 1995)

Regulations

Purchase

FORM 2 : CERTIFICATE BY DEDICATED OFFICIAL

[Regulation 12]

PROMOTION OF NATIONAL UNITY AND RECONCILIATION ACT, 1995 (ACT 34 OF 1995)

(This form must be completed by the dedicated official (an official in the TRC Unit) when

verifying whether the person who needs assistance is a victim or a relative or dependant of a victim)

* Mark appropriate block with an X

A.	PARTICULARS OF PERSON WHO NEEDS ASSISTANCE IN TERMS OF REGULATION 10

Name of person who needs assistance:

ID number/Date of birth:

Date of application received:

B.	VERIFICATION BY DEDICATED OFFICIAL

The person mentioned in Part A is a—

(a)

VICTIM:

*Yes / No

TRC reference check

*Yes / No

TRC reference number of victim

Additional documents / information received

*Yes / No

If Yes, specify

(b)	RELATIVE OF A VICTIM *Yes / No

His or her relationship with the victim is as follows: ..........................................................

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

(c)	DEPENDANT OF A VICTIM *Yes / No

The basis of his or her dependency on the victim is as follows:

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

C.	REMARKS BY DEDICATED OFFICIAL

D.	PARTICULARS OF DEDICATED OFFICIAL

Name and surname: ........................................

ID number: ........................................

Signature of dedicated official

Date of certificate