56 No. 41970
GOVERNMENT GAZETTE, 12 OCTOBER 2018
L0000000001
7 years and above
A9.
PHOTO
DHA-24/A
LEFT RING
FINGERPRINTS FOR THE NOTICE OF BIRTH
DO NOT PHOTOCOPY
PLEASE NOTE: Fingerprints may only be taken by an official of the Department of Home
Affairs. Should a finger be missing, deformed or so injured that the impression cannot
be taken, this fact should be noted in the space provided for that impression
FINGERPRINTS OF:
Please tick appropriate box
PERSONAL PARTICULARS
RIGHT RING
No photo required for
informant
No photo is required
where the child is younger
than 7 years
CHILD/ADULT
INFORMANT
LEFT MIDDLE
CHILD
Surname
___________________________________________________________________
Forenames
___________________________________________________________________
Date of Birth
(YYY/MM/DD)
INFORMANT
Surname
___________________________________________________________________
Forenames
___________________________________________________________________
RIGHT MIDDLE
LEFT SMALL
RIGHT SMALL
Photo of the CHILD only
LEFT INDEX
FINGERPRINTS TAKEN BY: PLEASE PRINT FULL NAME
PERSAL NUMBER
RIGHT INDEX
Identity No./
Passport No.
Verification results (HANIS):
RETURN THE FORM TO:_________________________________________________________
LEFT THUMB
RIGHT THUMB
Name of Regional Office (or head office: population register, if foreign birth)
REGISTERING FINGERS
NO.1
-
NO.2
Departmental office stamp - Office of origin
LEFT THUMB
RIGHT THUMB
Page 4 of 9
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