SAPS 590(a)

SOUTH AFRICAN POLICE SERVICE

AFFIDAVIT BY STATION COMMANDER TO FURNISH INFORMATION TO COURT

Section 5(3)(a) of the Protection from Harassment Act, 2011 (Act No 17 of 2011)

TO BE COMPLETED IN DUPLICATE

This affidavit must be handed to the clerk of the court, at the request of the complainant or clerk of the court, when the complainant or person applies for an interim protection order in terms of section 2 of the Act.

AFFIDAVIT NO: ................................................................................./ 20...................                                   DIRECTION NO: ............................................../   20................•..

To:.......................................................................................................................................(name and surname of clerk of the court identified in the direction).

I, Persal number .............................................................................Rank ............................. Name and surname ....................................................................................stationed at (physical address)............................................................................................................................with contact number ...................................................and fax number ............................................................................ state under oath as follows :

1.

In terms of the direction of the court, I was ordered to investigate the alleged harassment of the complainant or related person to determine the name and address or any other information which may be of assistance to identify or trace the respondent.

2.

*As a result of the investigation, the following information of the respondent has been gathered:

Name and surname of respondent: ..........................................................................................................................................................................................................

Address of the respondent: .....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

The following information has been gathered in order to identify and trace the respondent:

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

(Any documentation obtained which may be used to identify or trace the respondent must be attached as an annexure to this Form)

The above statement was made by me at the place, date and time as indicated.

*I know and understand the contents of this statement.

I have no objection to taking the prescribed oath.

I consider the prescribed oath to be binding on my conscience.

OR

*I truly affirm that the content of this statement is true.

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SIGNATURE OF STATION COMMANDER

I certify that the deponent has acknowledged that he/she* knows and understands the contents of this statement which was sworn to/affirmed* before me and the deponent's signature was placed thereon in my presence.

Signed and sworn to / solemnly confirmed* in my presence on this....................................................... day of .................................................20............. at .....................................................(place) at .........................(time).

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COMMISSIONER OF OATHS

Full names and surname:  ..........................................................................................................................................

Designation: ..............................................................................................................................................................

Area for which appointed : .........................................................................................................................................

Business address : ......................................................................................................................................................

TO BE COMPLETED BY THE CLERK OF THE COURT ON RECEIPT OF THE AFFIDAVIT

I, ...............................................................................................................................................................................................................(name and surname of the clerk of the court), hereby certify that I have received the affidavit from ............................................................................................................................................................................................(name and surname of person who furnished affidavit to clerk of the court) on..................................................(date).

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CLERK OF THE COURT