No. 41970   63 STAATSKOERANT, 12 OKTOBER 2018 G.P.-S 09/18 DHA-19 CONFIRMATION OF BIRTH (For non-South African citizens) [Births and Deaths Registration Act 51 of 1992] Section 9, Regulation 7(2) And 8(5) CB000000001 Annexure 5 ISSUED WITHOUT ERRORS OR ALTERATIONS Note: This is not a birth certificate. PLEASE register the birth of the child listed in this confirmation of birth in your country of citizenship. It is the responsibility of the parent(s) to obtain a passport for the child from their country of origin/Nationality and thereafter apply for a Visa/Permit for the child to sojourn in RSA. A. PARTICULARS OF CHILD Surname Forenames in full Date of birth Y Y Y Y M M M M M M M M M D D (write month in full) Sex: Country of Birth Place of birth: City/Town B. PARTICULARS OF MOTHER / PARENT A Passport No / ID No. Date of birth Y Y Y Y M M M M M M M M M D D (write month in full) Refugee/Asylum Seeker Permit PR Permit No. Surname Maiden/Previous surname Forenames in full Place of birth: City/Town Country of birth Nationality C. PARTICULARS OF FATHER / PARENT B Passport No / ID No. Date of birth Date of birth Y Y Y Y M M M M M M M M M D D Y Y Y Y M (write month in full) Refugee/Asylum Seeker Permit PR Permit No. Surname Forenames in full Place of birth: City/Town Country of birth Nationality D. ENDORSEMENTS Director-General Office Stamp Page 1 of 1 This gazette is also available free online at www.gpwonline.co.za M D D