42   No. 41970 GOVERNMENT GAZETTE, 12 OCTOBER 2018 Allocated Identity Number: B0000000001 PART A: BIRTH REGISTRATION [Births and Deaths Registration Act 51 of 1992] To be completed in full and submitted at the Department of Home Affairs’ office or to a South African embassy or consulate. The form to be completed in BLACK INK with BLOCK LETTERS. Please tick with þ the CORRECT box, where required. Write LEGIBLY . Applications that are not legible shall not be accepted. Date of application Y Y Y Y M M M M M M M M M D D Y Y Y Y M M M M M M M M M D D A1. DETAILS OF THE CHILD Surname Forenames in full Date of birth Are the parents of the child married to each other? Yes Sex: No NOTE: If twins or more, provide time of birth for each child. For each child, complete separate form and submit all forms together. Child 1: Time Child 3: Time Child 5: Time Child 2: Time Child 4: Time Child 6: Time Place of birth: City/Town Province Country of birth NOTE: For applications related to false registration, please indicate details of correct parents that should be reflected A2. DETAILS OF MOTHER (PARENT A) (In the case of Civil Union this section must be completed by the natural mother) ID No./ Passport No./ PR/ Refugee/ Asylum Seeker No. if foreigner Y Y Y Y M M M M M M M M M D D Left thumb of Mother/ Parent A Date of birth Present surname Maiden surname Forenames in full Place of birth: City/Town Country of birth Residential address Street Town/Village Province Telephone no., incl. area code Cell phone no. Postal code E-mail address Citizenship A3. DETAILS OF FATHER (PARENT B) ID No./ Passport No./ PR/ Refugee/ Asylum Seeker No. if foreigner Y Y Y Y M M M M M M M M M D D Left thumb of Father/ Parent B Date of birth Present surname Maiden surname Forenames in full Place of birth: City/Town Country of birth Residential address Street Town/Village Telephone no., incl. area code Province Cell phone no. E-mail address Citizenship Page 2 of 10 This gazette is also available free online at www.gpwonline.co.za Postal code