Telecommunications Request
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3J591E
28
REPUBLIC OF SOUTH AFRICA
FORM 9
[Regulation 10]
AFFIDAVIT FOR PURPOSES OF FURTHER WARRANT OF ARREST
SECTION 8(3) OF THE DOMESTIC VIOLENCE ACT, 1998 (ACT NO.116 OF 1998)
IN THE MAGISTRATE’S COURT FOR THE DISTRICT OF ____________________
HELD AT ___________________
APPLICATION NO._______/_____
In the matter between:
APPLICANT: ______________________________________________________
(*Id.No./Date of Birth:_________________________________)
AND
RESPONDENT: ____________________________________________________
(*Id.No./Date of Birth:_________________________________)
PART A : AFFIDAVIT
(To be completed by complainant)
1. PARTICULARS OF COMPLAINANT
Surname :
Full names :
Id.No / Date of birth :
Home or
temporary address :
Home/contact telephone
number :
Work address :
Work telephone number :
Occupation :
Department of Justice and Constitutional Development
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