Statistics Act, 1999
R 385
Social Assistance Act, 2004 (Act No. 13 of 2004)RegulationsRegulations relating to the Lodging and Consideration of Applications for Reconsideration of Social Assistance Application by the Agency and Social Assistance Appeals by the Independent TribunalAnnexure A : Consolidated FormsForm 12 : Withdrawal of an Application for ReconsiderationCape Town |
FORM 12
WITHDRAWAL OF AN APPLICATION FOR RECONSIDERATION
(Regulation 3(7))
[Section 18(1A) of the Social Assistance Act 13 of 2004]
ATTENTION: Regional Executive Manager
South African Social Security Agency
Private Bag X9189
Cape Town
8000
A. PERSONAL DETAILS OF APPLICANT OR BENEFICIARY
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I, the undersigned, hereby withdraw my application for reconsideration dated ............ My reasons for withdrawing the application for reconsideration are as follows:
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(Signature of applicant or beneficiary or representative)
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(Date)
E. REPRESENTATIVE'S DETAILS
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Name and Surname: |
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ID Number: |
Date of Birth |
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Telephone No:
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