SAPS 590(b)

SOUTH AFRICAN POLICE SERVICE

AFFIDAVIT BY MEMBER TO FURNISH INFORMATION TO COURT

Section 6(3)(b) 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...................

To the clerk of the Magistrate's Court for the district: ..............................................................................................................................................................................................................................

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

1.

On (date) ................................................... ., the complainant made an affidavit that he or she intends to apply for a protection order against harrassment.

From the affidavit of the complainant , which is attached as Annexure A, it appears that there are reasonable grounds to believe that the respondent whose name and address are unknown to the complainant, has been or is harassing the complainant or related person.

2.

The complaint was investigated in accordance with section 6 (1) of the Protection from harassment Act, 2011 to determine the name and address of the respondent.

3.

*As a result of the investigation, the following information 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)

OR

•After a reasonable investigation of the matter , I was unable to determine the name or address of the respondent. 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.

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

SIGNATURE OF DEPONENT

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 I solemnly confirmed* in my presence on this ....................... day of .................................20............. at .......................................(place)

at  .........................(time).

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

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).

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

CLERK OF THE COURT