STAATSKOERANT, 12 OKTOBER 2018 No. 41970   65 DHA -529 C. FATHER’S PARTICULARS 1. SURNAME...................................................................................................................................................................................................... 2. FORENAMES (in full) ..................................................................................................................................................................................... 3. DATE OF BIRTH ................................................................................ 5. IDENTITY NUMBER 6. (a) If he was born outside South Africa, the date on which he entered South Africa for the first time for permanent residence: (a) ............................................................................................................................................................................................................... (b) Period(s) (dates) of his residence in South Africa ................................................................................................................................. (c) Number of immigration permit and date of issue ................................................................................................................................... (d) Number of certificate of naturalisation and date of issue ...................................................................................................................... 7. 8. 4. PLACE OF BIRTH .................................................................... If he was absent from South Africa state— (a) Date(s) of his departure ......................................................................................................................................................................... (b) Reason(s) for his departure ................................................................................................................................................................... (c) Date on which he returned to South Africa permanently ....................................................................................................................... Particulars in respect of foreign citizenship: (b) Date and place of acquisition .............................................. (a) Citizenship acquired (country) ................................................... (c) Means of acquisition of foreign citizenship, i.e. marriage, naturalisation, descent or registration?....................................................... D. MOTHER’S PARTICULARS 1. SURNAME ......................................................................................... 2. MAIDEN NAME ........................................................................ 3. FORENAMES (in full) ..................................................................................................................................................................................... 4. DATE OF BIRTH ................................................................................ 6. IDENTITY NUMBER 7. (a) 5. PLACE OF BIRTH .................................................................... If she was born outside South Africa, the date on which she entered South Africa for the first time for permanent residence: ............................................................................................................................................................................................................... 8. 9. (b) Period(s) (dates) of her residence in South Africa................................................................................................................................. (c) Number of immigration permit and date of issue ................................................................................................................................... (d) Number of certificate of naturalisation and date of issue ...................................................................................................................... If she was absent from South Africa state— (a) Date(s) of her departure......................................................................................................................................................................... (b) Reason(s) for her departure................................................................................................................................................................... (c) Date on which she returned to South Africa permanently ..................................................................................................................... Particulars in respect of foreign citizenship: (b) Date and place of acquisition .............................................. (a) Citizenship acquired (country) ................................................... (c) Means of acquisition of foreign citizenship, i.e. marriage, naturalisation, descent or registration?....................................................... E. CERTIFIED THAT THE INFORMATION FURNISHED ABOVE IS CORRECT DATE ............................................................................ SIGNATURE .................................................................................. ADDRESS ..................................................................................... ....................................................................................................... ....................................................................................................... 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