64   No. 41970 GOVERNMENT GAZETTE, 12 OCTOBER 2018 DHA-529 G.P.-S. 017-0666 DEPARTMENT: HOME AFFAIRS REPUBLIC OF SOUTH AFRICA DETERMINATION OF CITIZENSHIP STATUS DEPARTMENT OF HOME AFFAIRS INFORMATION TO BE FURNISHED IN FULL IN ORDER TO ASSIST IN DETERMINING YOUR CITIZENSHIP UNDER THE SOUTH AFRICAN CITIZENSHIP ACT, 1995 (ACT 88 OF 1995), WHICH CAME INTO OPERATION ON 6 OCTOBER 1995 A. PERSONAL PARTICULARS 1. SURNAME ......................................................................................... 2. MAIDEN NAME ........................................................................ 3. FORENAMES (in full) ..................................................................................................................................................................................... 4. DATE OF BIRTH ................................................................................ 6. IDENTITY NUMBER 7. If born outside South Africa, please state— 5. PLACE OF BIRTH .................................................................... (a) Date on which you first entered South Africa for permanent residence ................................................................................................ (b) The period(s) (dates) of your residence in South Africa ........................................................................................................................ (c) Number of immigration permit and date of issue ................................................................................................................................... (d) Number of certificate of naturalisation and date of issue ...................................................................................................................... 8. If born in Namibia, please state your permanent residential address as on 1990-03-21 .............................................................................. 9. If you were absent from South Africa state— (a) Date(s) of your departure....................................................................................................................................................................... (b) Reason(s) for your departure................................................................................................................................................................. (c) The date on which you returned to South Africa permanently............................................................................................................... 10. Particulars in respect of foreign citizenship: (a) Citizenship acquired (country) ................................................... (c) Means of acquisition of foreign citizenship, i.e. marriage, naturalisation, descent or registration? (Please attach copy / proof (d) thereof) .................................................................................................................................................................................................. (d) Did you apply for the retention/re-instatement of South African citizenship? YES/NO. If YES, attach a copy of the relevant certificate. 11. Date of marriage of your parents ...................................................... (b) Date and place of acquisition.................................................. 12. Place of marriage of your parents .......................................... B. MARITAL STATUS 1. Please furnish the following particulars in respect of your spouse: (a) SURNAME ................................................................................. (b) MAIDEN NAME ....................................................................... (c) FORENAMES (in full)............................................................................................................................................................................. (d) DATE OF BIRTH........................................................................ (f) IDENTITY NUMBER OF YOUR SPOUSE (g) Date on which he/she entered South Africa for the first time for permanent residence ........................................................................ (h) Period(s) (dates) of residence in South Africa ....................................................................................................................................... (e) PLACE OF BIRTH................................................................... (i) rDate of your marriage................................................................ (j) Place......................................................................................... (k) If applicable, the date of your husband’s/wife’s death or your divorce .................................................................................................. (l) rNationality of your spouse...................................................................................................................................................................... This gazette is also available free online at www.gpwonline.co.za