72   No. 41970 GOVERNMENT GAZETTE, 12 OCTOBER 2018 D. DECLARATION BY AUTHORISED PERSON BARCODE I, the undersigned, hereby declare that: (choose the applicable option) a) I was present at the above mentioned death / saw the body. b) I did not witness the death and did not see the body. The certificate is issued in good faith, as informed by the person whose particulars appear in Part C. c) The information furnished in Parts A and B is to the best of my knowledge and belief true and correct. d) A medical practitioner has not certified the cause of death as, one was not available to do so. Was the deceased a female person known to be pregnant? Yes No Don’t know I, the undersigned, hereby declare under oath that the information submitted in this form and supporting documents are to the best of knowledge and belief true and correct. I understand that a false statement is punishable under section 31 of the Births and Deaths Registration Act 51 of 1992. Date signed Signature Y Y Y Y M M D D Place signed E. PARTICULARS OF AUTHORISED PERSON Left thumbprint of authorised person I, the undersigned, hereby certify that the information provided above is to the best of my knowledge and belief true and correct Identity number Date of birth Y Y Y Y M M D D Designation no. Surname Forenames Residential address Street Town Postal code Province Telephone number (office) Cellphone no. E-mail address: Office Stamp Signature Date signed Y Y Y Y M M D D F. FORM DELIVERED TO HOME AFFAIRS OFFICE BY Identity no. (passport if foreigner) Surname Forenames Relationship to the deceased Parent Spouse Child Other, specify Status Approved G. FOR OFFICIAL USE ONLY The information stated above has been verified by Need investigation Office stamp Surname Forenames Persal no. Rank Signature Date signed Documents included with this application: Y Y Y Y M M D D Original ID of Deceased Copy of ID document of the informant Copy of ID of Authorised Person Copy of Authorisation Letter issued to Authorised Person This gazette is also available free online at www.gpwonline.co.za