44   No. 41970 GOVERNMENT GAZETTE, 12 OCTOBER 2018 B0000000001 A6. DETAILS OF THE APPLICANT / NEXT OF KIN / LEGAL GUARDIAN / SOCIAL WORKER (if Applicant is not the parent, please complete and submit Form DHA-288/B, where applicable) Relationship to child, if next of kin: ID No./ Passport No./ PR/ Refugee/ Asylum Seeker No. Date of birth Y Y Y M M D D (Attach copy of Court order) Thumbprint Social Workers Case No: Y Surname Forenames in full Initials and surname Signature A7. FOR OFFICIAL USE ONLY - FRONT OFFICE CLERK Office stamp - Office of Origin APPLICATION RECEIVED AND VERIFIED BY: Surname First name User ID Stat I Birth O S M DOCUMENTS SUBMITTED WITH THIS APPLICATION: PLEASE TICK þ Proof of Birth Form (DHA-24/PB) Paternity test results (if applicable) Certified copy of the Foreign birth certificate of the child Certified copy of Mother’s/Parent A’s ID Copy of valid passport (all pages) Citizenship determination Form DHA-529 (SA Parent) Certified copy of Father’s/Parent B’s ID (if applicable) Certified copy of court order (abandoned/ orphaned children) Citizenship determination Form DHA-529 (Child) Certified copy of Next of kin / Legal Guardian/Social Worker’s ID Certified copy of death certificate (if applicable) Copy of refugee permit (s24 ito Refugees Act), if applicable Certified copy of Marriage / Civil Union/ Customary Marriage Certificate of parents (if married) Copy of Asylum Seeker permit (s22 ito Refugees Act), if applicable DHA-1658 if married religiously i.e. Muslim, Hindu Copy of permit (ito Immigration Act), if applicable Certified copy of Social Worker’s Registration Certificate Online verification performed and printouts attached for following persons: Mother (Parent A) Date Y Y Y Father (Parent B) Y M M M M Next of Kin M M M M Legal guardian M D A8. APPLICATION RECEIVED AND VERIFIED: (SUPERVISOR) Social worker D Person who witnessed birth Signature STATUS Approved Rejected I , ______________________________________________________________________ hereby declare that I have received and verified the application, as indicated above approved / rejected* the application for a birth certificate. (* delete whichever is not applicable) User ID Date Y Y Y Y M M M M M M M M M Page 4 of 10 This gazette is also available free online at www.gpwonline.co.za D D Signature