ANNEXURE A

• Houses(Rdp)
• Security
• Comfort

CLAIM/APPLICATION FORM: HOUSING (RDP)

APPLICATION FOR RE-CLAIM AND APPROVAL OF HOUSES (RECONSTRUCTION AND

DEVELOPMENT PROGRAMME) - GENERAL NATIONAL DEPARTMENT OF HUMAN
SETTLEMENTS

NEW APPLICATION CLAIM (Mark with X) fill with black pen only

PART 1 PARTICULARS OF APPLICANT

1.1 Name of Province:
1.2 Name of Municipality:
1.3 Date/s of the disaster
1.4 GPS co-ordinates of location of disaster
1.5 Postal Address of applicant
1.6 Physical address of applicant
1.7 Contact Person: (Name and surname, designation, telephone
number, fax number, email address).

PART 2 DESCRIPTION OF EMERGENCY HOUSING SITUATION

2.1 Brief description of the emergency housing situation, e.g., flood, fire, or other reasons.

2.1.1 Description of location and cause of the emergency housing situation (attach location map).

2.1.2 Describe level of destitution/displacement and impact on persons.

2.2 Nature, scope, and extent of the emergency housing situation: Provide a full and detailed description of the emergency
housing situation, including, among other matters, the nature of the emergency housing situation that needs to be redressed,
e.g., whether land, municipal engineering services, and/or shelter is required, or the repair or reconstruction of damaged formal
housing.

2.3 Has the Mayor agreed to this application? (compulsory) Yes No ✔

2.4 Has the Provincial Disaster Management Centre been informed of this application? (Compulsory) Yes No ✔

PART 3 COMMUNITY PROFILE

3 Together with the application, the Municipality must submit a community profile containing the following particulars (as per
the attached assessment form):

3.1 The number of affected persons, households, and families.

3.2 An income profile of the families.
3.3 The number of persons unemployed.
3.4 Whether relocation/resettlement is required, and, if so, full reasons
PART 4 LAND, MUNICIPAL INFRASTRUCTURAL SERVICE AND SHELTER
4.1 If land is required, provide the following information:
4.1.1 Whether the current settlement is in an urban, rural, communal land area, or other area (e.g. commercial farm, etc.).

4.1.2 Settlement pattern before the occurrence of the event which caused the emergency housing situation.

4.1.3 The nature of the current property rights of the persons concerned, e.g., illegal, informal settlement, tribal settlement, communal
tenure rights, rent, leasehold, full ownership, etc.

4.1.4 Have the affected persons been consulted, and have their consent and commitment to cooperation been obtained. If not, provide
full particulars, including time frames, of the steps that will be taken to obtain their support and commitment.

4.1.5 Has land been identified for possible settlement, and if so:
a) The location, description, and extent of the land.

b) In whose ownership is the land.

c) On what basis will the land be made available, e.g., donation, lease or purchase, and what are the terms and costs involved in
each case.

d) Are there any restrictions that will impede or preclude the use of land for temporary/permanent residential purposes in terms of,
for instance, its title deeds, integrated development planning, the Environmental Conservation Act, 1991, or any other legisla-
tion? If so, how will these restrictions be removed?

e) Does the land form part of an established housing development or on land that has been identified for housing purposes.

f) If land has not yet been identified, provide full particulars, including time frames and estimated costs of the steps that will be
taken to identify and acquire land.

4.1.6 Full particulars about the time frames and costs of preparing a layout plan for the area of settlement.

4.2 If municipal engineering services are required, provide the following information:
4.2.1 Full details of any municipal engineering services that are currently available or were available at the time of the occurrence of the
event which caused the emergency housing situation. Provide:
a) Full particulars about the municipal services that are required;

b) Detailed reasons for the necessity to provide them under this programme; and
c)

d) Full particulars of the estimated costs of, and the manner in which it is intended to install, the proposed municipal infrastructure.

4.2.2 The municipality must, together with the submission of this application, provide a written undertaking that it will:
a) pending the installation of the municipal engineering services , provide basic municipal services to the affected persons in the
form of water, refuse removal, and sewage removal services (where applicable) at affordable tariffs; and

b) be able to provide bulk and connector services to the settlement area.

4.3 If shelter is required, provide the following information:

4.3.1 A full description of the accommodation that existed in the community before the occurrence of the event which caused the emer-
gency housing situation.

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4.3.2 Full and particularised information about:
a) the number of persons for whom the shelters will be erected;
b) the nature and description of the proposed structure that will be erected;
c) the number of shelters to be erected;
d) full and particularised details of all material required for the construction of the shelter; and

e) the estimated costs involved in the provision of shelter and the manner in which it is intended to provide shelter; and

f) the sourced material must comply with the Municipal IDP,National Building Regulations and SABS standards

g) any others costs required to execute the project.

4.3.3 Does the municipality have the capacity to provide training to affected persons on how to erect their own structures and to su-
pervise the construction of the shelters, if applicable? If not, what steps does the municipality intend taking to acquire the required
capacity.

4.4 Relocation/resettlement
In the event of relocation and resettlement of persons, the municipality, must together with this application, submit a written under-
taking that it will comply with all the prescripts relating to relocation and resettlement

PART 5 STEPS TAKEN TO DATE

5.1 Provide details of all actions the municipality or any other person or institution has taken since the occurrence of the event which
caused the emergency housing situation to improve the situation or address the emergency housing situation.

5.2 Provide a list of other persons or institutions who have a substantial interest in the situation and provide details of such interest.

5.3 Has the emergency housing situation been declared a state of disaster in terms of the
Disaster Management Act, 2002? (OPTIONAL)

5.4 If so, what actions have been taken in terms of the Act?

PART 6 CAPACITY STATUS AND ARRANGEMENTS

6.1 Institutional Capacity:
Provide a brief description of the capacity available to address the emergency housing situation in terms of managerial and
technical capacity available to manage, plan and implement the project.

6.2 Financial Capacity:

6.2.1 Provide confirmation from the Director-General National Department of Human Settlements that funds are available for the
project.

Provide a description on the capacity to manage, control and administer funds, as well as the capacity to provide or arrange/
negotiate other sources of additional funds for purposes of the emergency housing situation.

6.2.2 Cash Flow Projections outlining the utilisation of the funds

6.3 If the municipality lacks sufficient capacity to execute the project, indicate how it is envisaged to augment its current capacity in
order to address the emergency housing situation?

6.4 Provide details on the proposed contracting strategy and emergency procurement strategy as guided by MFMA/PFMA/Treasury
regulations

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PART 7 LINKAGES WITH EXISTING AND/OR OTHER PROGRAMMES
7.1 Can this project in any way be linked to any other public or private programmes, housing or otherwise, that may in any way
assist in redressing the emergency housing situation?

7.2 Provide a detailed plan on achieving a permanent housing solution for the effected persons.

PART 8 FURTHER INFORMATION

8.1 Provide any further information relating to the emergency housing situation, which in the opinion of the municipality and/or the
province will assist the Mayor taking a decision.

PART 9 PROPOSED PROJECT BUSINESS PLAN

9.1 Provide a detailed project business plan that includes financial flow details.

Signed at _______________________________ on the (day) of (month) (year)

in the presence of the undersigned witnesses

WITNESS

1. ________________________________
PRINT NAME SIGNATURE

2. ________________________________
PRINT NAME SIGNATURE

_______________________________________________________________
SIGNATURE: CITY/MUNICIPALITY MANAGER
(delete which is not applicable)

______________________________________________________________
SIGNATURE: EXECUTIVE MAYOR

APPLICATION TO BE CONSIDERED IN LINE WITH EMERGENCY HOUSING PROGRAMME WITHIN THE NATIONAL HOUSING CODE.