Form 11 - Department Of Justice
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1J645E
35
REPUBLIC OF SOUTH AFRICA
FORM 11
[Regulation 12(1)]
NOTICE TO APPEAR BEFORE COURT
SECTION 8(4)(c) OF THE DOMESTIC VIOLENCE ACT, 1998 (ACT NO.116 OF 1998)
CASE NO. ___________________
IN THE MAGISTRATE`S COURT FOR THE DISTRICT _______________________
HELD AT ___________________________
COURT _______________________
DATE OF TRIAL _____________________
TO :
Name of Respondent:
Home address:
Sex:
Occupation/Status:
Id No./Date of birth:
You are hereby notified that you must appear personally before the above-
mentioned Court on the date stated above at 08:30 on the following charge:
PARTICULARS OF CHARGE:
You are guilty of the offence of contravening section 17(a) of the Domestic Violence
Act, 1998 (Act No. 116 of 1998), in that upon or about the _____________ day of
_______________________ and at or near _______________________________
in the district of _______________________________________________ you
__________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
__________________________________________________________________.
Note:
(1) Please produce this document to the Clerk of the Court on the date of trial.
(2) By failing to appear before the Court as notified you may be convicted of an
offence and upon conviction be sentenced to a fine or imprisonment for a
period not exceeding six months.
CERTIFICATE :
I _____________________________________________(rank and name), in my
capacity as a member of the South African Police Service stationed at
______________________, hereby certify that I have handed the original of this notice
to the Respondent mentioned therein at ____________________________(place) on
_____________(date) and that I explained the contents thereof to the said
Respondent.
______________________________________________
(Name, rank and service no. of Member and date)
Department of Justice and Constitutional Development
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