ChildrensAct - J767 (20230315)
ChildrensAct - J767 (20230315)
ChildrensAct - J767 (20230315)
FORM 2
BRINGING MATTER TO COURT IN TERMS OF SECTION 53 CHILDREN'S ACT, 2005 (ACT NO. 38 OF 2005)
File No:….........................................................….
[If the space provided for is inadequate, submit information as an Annexure to this form and sign each page.]
PART A: PARTICULARS OF CHILD(REN)
Surname:
Full names and gender:
Child 1
Child 2
Child 3
Child 4
Child 5
ID. No./Date of birth: Child 1 / /
Child 2 / /
Child 3 / /
Child 4 / /
Child 5 / /
Residential address(es):
(If the addresses are not the same for
each child please indicate the addresses
on a separate page.) Code ( )
Residential telephone number: (if any) (If
the numbers are not the same for each
child please indicate the numbers on a
separate page.)
Cellular number:(if any) Child 1
Child 2
Child 3
Child 4
Child 5
Physical address (where documents can
be served): (If the addresses are not the
same for each child please indicate the
addresses on a separate page.)
Code ( )
Surname:
Full names
ID. No./Date of birth: / /
Capacity or relationship of person acting
in terms of section 53(2):
Registration number of corporate body(if
applicable):
Residential address:
Code ( )
Residential telephone number:
Cellular telephone number:
Work address:
Code ( )
Work telephone number:
Fax number:
Physical address (where documents can
be served):
Code ( )
E-mail address:
2
DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT
J767
Surname:
Full names
ID. No./Date of birth: / /
Capacity of person acting in terms of
section 53(2)(b)-(e):
Registration number of corporate body(if
applicable):
Residential address:
Code ( )
Residential telephone number:
Cellular telephone number:
Work address:
Code ( )
Work telephone number:
Fax number:
Physical address (where documents can
be served):
Code ( )
E-mail address:
PART C
PARTICULARS OF PERSONS HAVING AN INTEREST IN THE MATTER
Surname:
Full names:
ID. No./Date of birth: / /
Capacity of person acting in
terms of section 53(2)(b)-(e):
Registration number of
corporate body: (if applicable)
Residential address(if
applicable):
Code ( )
Phone number(h): ( )
3
DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT
J767
Business address:
Code ( )
Phone number(b): ( )
Fax number: ( )
E-mail address:
PART D:
PARTICULARS OF MATTER
Nature of matter brought to court:
(Please give full details of the matter
e.g., registration/amendment of
parenting plans, removal of child to
safe care, children in need of care
and protection, placement in youth
care centers, adoption etc.)
……………………………………………………………………………..
Signature/thumbprint/mark of person bringing the matter to court
……………………………………………………………………………….
Full names of person witnessing person who made a thumbprint/mark
………………………………………………………………………………...
Signature of witness to thumbprint/mark
4
DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT