Form J294 - Death Notice - Republic Of South Africa - Department Of Justice

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J294

(81/816066)

REPUBLIC OF SOUTH AFRICA

DEATH NOTICE

(In terms of section 7 of the Administration of Estates Act, 1965)

…………………………………………………………………………………………………………………..

1. Surname of deceased

…………………………………………………………………………………………………………………..

2. Full first names

3. ID/Passport number

…………………………………………………..

………………………………………….

4. Population group

5. Nationality

……………………………………………………………………………………………………….…………..

6. Occupation

7. Ordinary place(s) of residence during the 12 months prior to death and the Province(s) ……………………………………………………

9. Place of birth ………………………………………………

8. Date of birth

10. Date of death

11.Has the deceased left a will? ………………………………….

…………………………………

12. Marital status at time of death

……………………………………………………………………………………………………………..

13. If married, place where married

……………………………………………………………………………………………………………..

14. Full names of surviving spouse

……………………………………………………………………………………………………………..

and his/her ID/Passport number

15. State whether marriage was in or out of community of property/whether accrual system is applicable.

…………………………………………………………………………………………………………………………………………………………

(a) Name(s) of predeceased spouse(s) and/or divorced spouse(s) (state opposite name of each whether predeceased or divorced)

…………………………………………………………………………………………………………………………………………………………

(b) Date of death of predeceased spouse(s) ……………………………………………………………………………………………………

16. Master's office(s) where predeceased’s estate(s) is/are registered and number(s) of estate(s), if available

…………………………………………………………………………………………………………………………………………………………

17. Full names of children of deceased (state whether major or minor or predeceased and in the latter event, whether they left issue and,

if that be the case, the full names of such issue)

…………………………………………………………………………………………………………………………………………………………

18. Names of parents of deceased (state whether parents alive or deceased):

(a) Father …………………………………………………………………………………………………………………………………………..

(b) Mother ………………………………………………………………………………………………………………………………………….

19. Name and address of person signing the death notice ………………………………………………………………………………………

……………………………………………………………………………………………………………………………………..

20. *Capacity

21. (a) Was the signatory present at the deceased's death? ………………………………………………………………………………………

(b) If the answer to the previous question is no, did the signatory identify the deceased after his death?..............................................

Dated at ....................................................................... the ..................... day of ................................................... in the year ..................

..............................................................................................

Print Name

Signature

State whether signatory is surviving spouse, nearest blood relative or connection residing in the district in which death has taken place; or is

caused by such spouse, blood relative or connection to give this notice; or is required by the Master to submit this death notice.



If the answer to both questions is no, a death certificate or a certified copy must be submitted herewith.

DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT