No. 41970   53 STAATSKOERANT, 12 OKTOBER 2018 DHA-24/LRB G.P.-S. 09/18 Allocated Identity Number: L0000000001 APPLICATION FOR A BIRTH CERTIFICATE - LRB (AFTER 30 DAYS) Recent ID size photo of the child (required only for person whose birth is sought registered who is 7 years or older) [Births and Deaths Registration Act 51 of 1992] [Section 9] To be completed in full and submitted at the Department of Home Affairs’ office or to a South African embassy or consulate. The informant to present his/her original ID document. The form must be completed in black ink with BLOCK LETTERS. Please mark þ the CORRECT box, where required. Applications that are not legible shall not be accepted. PART A Date of application Y Y Y Y M M M M M M M A1. DETAILS OF THE CHILD M M D D After 30 days After 1 year Note: Fingerprints of child who is 7 years or older must be taken on Part A9 Surname as at birth Forenames in full Date of birth Y Y Y Y M M M M M M M M M D D Sex: Place of birth: City/Town Province Country of birth Postal code Are the parents of the child married to each other? Date of marriage If Yes, nature of marriage Y Y Y Y M M M M Civil M Telephone no., incl. area code M Customary M M M D Civil Union D Other Marriage certificate enclosed Yes Cell phone no. NOTE: If twins or more, provide time of birth for each child. For each child, complete separate DHA-24/LRB and submit all forms together. Child 1: Time Child 3: Time Child 5: Time Child 2: Time Child 4: Time Child 6: Time COMPULSORY SECTION Provide reason why the application for a birth certificate was not made within 30 days of birth in terms of section 9(1) of the Births and Deaths Registration Act 51 of 1992 A2. DETAILS OF MOTHER (PARENT A) ID No./ Passport No./ PR/ Refugee/ Asylum Seeker No. Date of birth Y Y Y Y M M M M M M M M M D D Thumbprint Surname Previous / 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. Date of birth Y Y Y Y M M M M M M M M M D D Thumbprint Surname Previous / 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 This gazette is also available free online at www.gpwonline.co.za Page 1 of 9 Postal code No