DHA-Form 48: Section 31 (2) (C) and Regulation (29)
DHA-Form 48: Section 31 (2) (C) and Regulation (29)
DHA-Form 48: Section 31 (2) (C) and Regulation (29)
REFERENCE NUMBER
1.15 Occupation :
Title: Surname:
Maiden name:
First names:
Place of birth: Country:
Nationality at birth: Date of Birth:
Passport Number:
Country
names and place
birth of Mirth
2
5. DETAILS REGARDING APPLICANT AND (if applicable) SPOUSE AND CHILDREN:
Have you or any of your dependants accompanying you ever been convicted of any
crime?
Is a criminal or civil case pending against you or any of your dependant
accompanying you?
Are you or any of your dependants suffering from tuberculosis or any other infectious
or contagious disease or any mental or physical deficiency?
Are you a member of, or adherent to an association or organisation advocating the
practice of social violence, or racial hatred?
If you replied to any of the questions above in the affirmative, please furnish full details.
I/We the undersigned, declare that the details reflected in this application and supporting
documents are true and correct and that i is my/our intention to reside/ work in the
t
Republic. undertake to inform the Department
I
of any change of address whilst the
application is being processed, with the understanding that in the event of failure to do so
the Department willnot be responsible for any breakdowncommunication.
in I/we,
furthermore, undertake to inform the Department of any change in relevant information or
circumstances that could influence the outcome of this application.
Official stamp
Signature of official accepting the application
(Department of Home Affairs
)