Statistics Act, 1999
R 385
Protection from Harassment Act, 2010 (Act No. 17 of 2010)RegulationsRegulations in terms of the Protection from Harassment Act 2011Annexure : Form 24 [Regulation 26] |
APPLICATION FOR VARIATION OR SETTING ASIDE OF PROTECTION ORDER
SECTION 13(1) OF THE PROTECTION FROM HARASSMENT ACT, 2011 (ACT NO. 17 OF 2011)
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IN THE MAGISTRATE'S COURT FOR THE DISTRICT OF .................................................................................................................................................
HELD AT ........................................................................................................ APPLICATION NO. .................................../...............................
In the matter between:
........................................................................................................................................................................................................(Applicant)
AND .........................................................................................................................................................................................................(Respondent) |
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PART A : AFFIDAVIT (To be completed by applicant) |
1. PARTICULARS OF APPLICANT
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Surname |
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Full names: |
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Identity number/Date of birth: |
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Home or temporary address:
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Home/contact telephone number/s: |
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Work address:
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Work telephone number: |
2. PARTICULARS OF RESPONDENT
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Surname |
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Full names: |
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Identity number/Date of birth: |
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Home or temporary address:
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Home/contact telephone number/s: |
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Work address:
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Work telephone number: |
3. PARTICULARS OF PROTECTION ORDER
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A protection order was granted on: |
(Date) |
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In the Magistrate's Court at: |
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Against : |
(Name of respondent) |
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Application Number: |
A certified copy of the protection order is attached.
4. APPLICATION REGARDING PROTECTION ORDER
(*Delete whichever is not applicable)
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I wish to apply for: |
*(a) The setting aside of the protection order |
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*(b) The amendment of the protection order as follows: .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... .......................................................................................................................................................................... |
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The reasons for my request are: |
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______________________________________________ |
____________________________________ |
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Signature of Deponent |
Date |
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PART B : CERTIFICATION (for official use) |
I certify that before administering the *oath / taking the affirmation I asked the Deponent the following questions and noted *her/his answers in *her/his presence as indicated below:—
(a) Do you know and understand the contents of the above declaration?
Answer_________________________________________________________
(b) Do you have any objection to taking the prescribed oath?
Answer_________________________________________________________
(c) Do you consider the prescribed oath to be binding on your conscience?
Answer_________________________________________________________
I certify that the Deponent has acknowledged that *she/he knows and understands the contents of this declaration which was *sworn to / affirmed before me, and the Deponent' s
signature was placed thereon in my presence.
Dated at __________________________________________________this ________________________________day of___________________________________________ 20___________
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Justice of the Peace / Commissioner of Oaths
Full Names:__________________________________________________________________________________________________________________________________________________
Designation:_________________________________________________________________________________________________________________________________________________
Area for which appointed:_____________________________________________________________________________________________________________________________________
Business Address:____________________________________________________________________________________________________________________________________________
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