70   No. 41970 GOVERNMENT GAZETTE, 12 OCTOBER 2018 E GOV543/83 11/13 OG 4C!J4LJ 4L .a I:T a, °aP 'I-b+arii+ ,{Jk:4L:?w4LfJ,4CJr4}iJ4LJ.Iar1t1-1b,,ayrA'1ar b A {h.il,g CA ,er4;J4CJ 11;ß1{C ,.é4CJ. lr P Cilb a iJ;il.ß1 eli a61 i¡baPegC,,ir[A'1traPéA ,.s4C. ape1.a._ 4C, (-,,yr{Çrlllrar[A'1}ar iJ,4 A .il-,,bkC.. C il- 1 4LJ r{ e 1 { rCI7 rbJA v . a°i[ `4L`4AJb4L°.Jw1J"1%k'o7 11.a.`4L 4Liii7ljrar`[A!1áP°a¡raP`4é J 4L.J, il" C`¡ A' fbr CAr' 4LJ,Lj.il16{r };.IiI:ß1J{Çil á' ÌC11brr[A'1Ïrar á a°pt; [rl1rCAe¡bar`i `1..4L aPC1;'a Ä{a:4:1aP.i¡a r{{[[4+i14AA''ar+r7.,,ag-{é rA, 44. ae1° ¡ J,gl i l ,J Jk G.P.-S. 09/09 r, Jh;il 1aP 4; ;J 1,1 }i°J.il ,,1I , `4LJiCJ4LJ Ja. 4¡:=f i1:ß1JiC b[A e e e REPUBLIC OF SOUTH AFRICA DEPARTMENT OF HOME AFFAIRS C i. .*}J :}il g. ;J di':J'il é }C }iLJiI J ,.4L il ,.};J 1 4i ;-'.J.4LJ,I11r" °r, NOTICE OF DEATH / STILL BIRTH . aPe1, }J4CJ1b`Ia 4L 4LI1J1r{[A'lra¢LlaP`z :J aJ ,,,, CA ij4A.yl4 i 7 °fbaP a 111411,44k1 IJt4CJ[Irb:iÌa `4 °ar; il¡. ,,'a e 4 '1r"Pr C ,,{AA'lC1P, k:il.1CA Pa ar`11 jF{''f6aP at±LP4Lie°i.°'}{4L{[A 4 ,4L.ay''{[Z°` a4: á 1ä°a°` 4C { ..4C:ßJ, il" 4CJ '`tiJREPUBLIC [A 1i1b {CA Iir;ß1.iB12r.a'laP`zl I C?6S.1110 r, brtA'1aP a°re 1 aP a` 11ÇA1P.i'1baP{rÄ 44. 4L:"J apV1oa.`,.4 r [Births and Deaths Registration Act 51 of 1992] [Regulations 11 and 14] OF SOUTH AFRICA DEPT OF HOME AFFAIRS il' 4CJ , ra ae°C'7a6+a:aP4;'a=}:J ;il.ßlJtCA a e1. a E. PARTICULARS OF FUNERAL UNDERTAKER 4i:Jil,t{Ç;IyJ{[A `}e1,. 4' -4L. s:J I 2 aP..nYgJ{[j.l,l.ra1P{[1ba°ii¡aP,rr; Instructions: Section E to be completed by Funeral Undertaker. The undertaker must take his or her finger print, the finger print of the deceased and the informant. Auth A C 4L r,4LJ r, 4L11 fiJLJ:'IA 'á"7``2y`}:-J ,f. J'4 J. J,4L. 4Ç,,°J C ;'á f4 a'e1' ag1 `14i'aa4 álJ, 4iCJI;1J[IaP aCd1.' ' i s44°°ß /la A AC{ P ' {C 16 CA tCA'1r[.,¡bai di_. I'Ir.i,. a Fire il:41,91414516$1114 agel a`z, `4 ---,,.,1y , 4C. iB A e e , A P A { 4r {[ 1 1:1aPCAiP 44CJ.il:ßii1,ß1iÇlbg{[A 4L. A,ppaPe11a.e1,.4C J.4L;1J; ilil- 1:$ il' A!CP±Qy ¡CA A' CA 1Ç{I: A'pC e1. 2 a41¡'a grP A'aPe1;a 1r[A';jrar , k,ilï,l 4LJ. `4á`:`4C:14':ji1Ç¡bÿ{[A'llraP,ijlra"";a4: 1.4L.'4L°`,J. i+Y`f4C.'i*4L.'J.YJ:4YJ,-'P'sT4L`,,'J;4C: Undertaker or Informant may submit the completed form to the nearest Home Affairs office. 47. Name of Funeral Parlour 48. DHA Designation No. 49. Company Reg. No. 50. SARS Reg. No. (Income tax reference no.) Details of Funeral Undertaker or Authorised Representative 51. No. (P (Passportt N No. if fforeigner) 51 Identity Id tit N i ) 52. Surname 53. Forenames 54. Business Address Street Town Province Postal Code Telephone No. (Office) Cellphone No. 56. Date of Cremation (if applicable) 57. Place of Burial (City / Town / Village) Province 59. Grave No. (if available) Office stamp of fune Name of person who collected the deceased: 60. Identity No. (Passport No. if foreigner) 61. Surname 62. Forenames Place signed DHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHADHAHADDHADHA Signature F. FOR OFFICIAL USE ONLY Office stamp o Registration of death approved, DHA-1663 received by (particulars of DHA official): 63. Identity No. CONFIDENTIALITY SEAL, DO NOT OPEN, TAMPERING WITH THIS FORM IS A BREACH OF CONFIDENTIALITY 64. Surname 65. Forenames Documents included with this notice: Copy of the deceased's ID Copy of ID document of the informant The DHA-1663 Notice of Death/Stillbirth is Confidential. This page can ONLY be opened by Statistics SA Officials. DHA-1663 was submitted by: i ai ai ai ai ai ai ai ai ai ., L.E, .L.E, i ai ai ai ai ai ai ai ai ai ., L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, !!J a'w a'w a'w a'w a'w a'w a'w a'w a'w a-.L L GOV543-83T Notice of Death-Stillborn DHA1663 154183.indd 5 .L1.e, DHA - 6 (if applicable) DHA - 1680 (if applicable) Informant Funeral Undertaker !! !i=1! 6!ai ai ai ai ai ai ai ., ai ai !i ai!ai!ai !ai !ai. !ai.!ai!ai !aiJ., !i ai! ai!ai!ai!ai.!ai.!ai!ai!aiJ., i.-! ! ! ! ! ! ! ! ! J L.E, .L.E, .L.E, .L.E, ?To: ell.L.E, ?To: ell.L.E, .L.E, .L.E, TO OPEN: FOLD ALONG PERFORATION AND TEAR !!!! !! !! !! !! !! !!!! JJ ! ! ! ! ! !! iPr ai ai ai ai ai ai ai ai ai ., TO OPEN: FOLD ALONG PERFORATION AND TEAR TO OPEN: FOLD ALONG PERFORATION AND TEAR 66. Persal No. ?To: E, L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L.E, .L1.e, This gazette is also available free online at www.gpwonline.co.za 2013/11/14 06:41:41 AM