STAATSKOERANT, 12 OKTOBER 2018 No. 41970   61 L0000000001 C5. FOR OFFICIAL USE ONLY- OFFICE OF ORIGIN Notice of birth and affidavit received by: Surname Forenames Persal number Departmental Stamp Signature Date Y Y Y Y M M M M M M M M M D D The deponent and the Commissioner of Oaths to initial each page of the Affidavit. FOR OFFICE USE ONLY DHA-25 APPLICATION FOR A BIRTH CERTIFICATE (AFTER 30 DAYS) - LRB Allocated Identity Number OFFICE DATE STAMP L0000000001 Identity Number Applicant User ID Signature Page 9 of 9 This gazette is also available free online at www.gpwonline.co.za