46   No. 41970 GOVERNMENT GAZETTE, 12 OCTOBER 2018 B0000000001 B2. Application for authority to assume another surname (Section 26, Act 51 of 1992). I, ............................................................................................................................................................................................................................................., hereby apply to assume the following surname Reasons for my application (Please tick [√ ]the CORRECT box) Change in marital status Assumption of biological father’s surname Protection of Witness i.t.o Witness Protection Act, 1998 (Act No. 112 of 1998) [Attach relevant request letter] I also wish to include in my application my spouse and minor children, whose particulars of birth are as follows (complete only if applicable): PARTICULARS OF SPOUSE Identity number Date of birth Y Y Y Y M M M M M M M M M D D Left thumbprint of applicant Present surname Forenames (in full) Place of birth Residential address Street Town / Village Code Telephone no., incl. area code Cell phone no. E-mail address Postal address Province PARTICULARS OF CHILDREN (only minor biological or adopted children may be included) Forenames in full and surname Date of birth Signature of applicant Date signed Y Y Y Y M M M M Identity number (if not available, birth entry number) Place of birth Signature of spouse (if applicable) M M M M M D D Date signed Y Y Y Y M M M M M M M M M D D M M D D PART C: AMENDMENT OF BIRTH REGISTRATION OF A CHILD BORN OUT OF WEDLOCK [Section 11(1) of the Births and Deaths Registration Act 51 of 1992] NOTE: Only for use by the natural parents and if legally married to each other. NO PAYMENT OF FEE WE ARE THE NATURAL PARENTS OF THE FOLLOWING CHILD (BORN OUT OF WEDLOCK) Identity number Date of Birth Y Y Y Y Registered Surname Forenames (in full) Place of Birth Postal address We have been married to each other since Y Y Y Y M M M M M M M M M D D and as evidence thereof, our marriage certificate is enclosed. We therefore apply for the amendment of the birth register of the above mentioned child in terms of section 11(1) of Act 51 of 1992. DECLARATION We declare under oath/solemnly that the particulars given above are to the best of our knowledge and belief true and correct. We understand that a false statement is punishable under section 31(1) of the Births and Deaths Registration Act 51 of 1992. Signature of father Signature of mother COMMISSIONER OF OATHS 1. I certify that before administering the oath/affirmation, I asked the deponents the following questions and wrote their answers in their presence: Thumbprint of Mother/ Parent A a) Do you know and understand the contents of this declaration? Father Mother b) Do you have any objection to taking the prescribed oath? Father Mother c) Do you consider the prescribed oath to be binding on your conscience? Father Mother Page 6 of 10 This gazette is also available free online at www.gpwonline.co.za Thumbprint of Father/ Parent B