SAPS 590(c)

SOUTH AFRICAN POLICE STATION

APPLICATION BY STATION COMMANDER FOR EXTENSION OF TIME OR CANCELLATION OF DIRECTION

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

If this application is filed by delivering it to the clerk of the court personally, it must be completed and submitted in duplicate.

DIRECTION NO: ....................................................................../ 20...................

AFFIDAVIT NO: ...................................................................../20......................                                                                                                                               APPLICATION NO: ......................../..........................

To: .................................................................................................................................................................................................................(The clerk of the court)

Fax number: ....................................................................................................

From: ............................................................................................................................................................................................................(*station commander I *designated member of ..............................................................................................................police station)

Fax number: .....................................................................................................                                                                     E-mail address of station commander : ..................................................................

Phone number of station commander : ........................................................................................

TO BE COMPLETED BY THE STATION COMMANDER :

I hereby apply for —

Indicate with "X" in the appropriate column

I, Persal number  ........................................................... Rank ........................................ Name and Surname ............ ..............................................................the station commander of the .......................................................................... police station, in support of this application hereby state under oath as follows:

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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 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 / 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 FILED IN TERMS OF REGULATION 15(2)(a) OF THE

PROTECTION FROM HARASSMENT REGULATIONS:

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