No. 41970   47 STAATSKOERANT, 12 OKTOBER 2018 B0000000001 2. I certify that the deponents have acknowledged that they know and understand the contents of this declaration which was sworn to/affirmed before me and the deponents’ signatures and thumbprints were placed thereon in my presence. Surname ...................................................................................................... Signature of informant Forenames Business address ...................................................................................................... Commissioner of Oaths ...................................................................................................... Designation (Rank) Office Stamp PART D: CHANGE OF FORENAME (Section 24 of Act 51 of 1992) STATE THE FORENAME(S) IN FULL AS IT SHOULD BE AFTER THE ALTERATION: STATE THE REASONS FOR THE CHANGE OF FORENAME(S) Date signed Y Y Y Y M M M M M M Signature of Applicant PART E: INSERTION OF NATURAL FATHER’S PARTICULARS IN THE BIRTH REGISTER OF A CHILD BORN OUT OF WEDLOCK [Section 11(4) and (5) of the Births and Deaths Registration Act 51 of 1992] To be signed by the BIOLOGICAL PARENTS of the child born out of wedlock in BLACK INK with BLOCK LETTERS. DECLARATION BY NATURAL FATHER • • • • I am the person whose particulars appear under C overleaf and that the particulars furnished are true and correct; I am the natural father of the child referred to in A overleaf; and I wish to be recorded as the natural father of the said child in his/her birth register. I understand that a false statement is punishable under section 31 of the Births and Deaths Registration Act, 1992. Signed at .......................................................................................... on this ........................ day of ........................................................................................... Thumbprint of Natural Father I, the undersigned, hereby declare that: Signature .......................................................................................... DECLARATION BY NATURAL MOTHER • • • • I am the person whose particulars appear under B overleaf and that the particulars furnished are true and correct; I am the natural mother of the child referred to in A overleaf; and I have no objection to the natural father referred to in C overleaf being recorded as the natural father in my child’s birth register. I understand that a false statement is punishable under section 31 of the Births and Deaths Registration Act, 1992. Signed at .......................................................................................... on this ........................ day of ........................................................................................... Signature .......................................................................................... Page 7 of 10 This gazette is also available free online at www.gpwonline.co.za Thumbprint of Natural Mother I, the undersigned, hereby declare that: M M M D D