Form 12 - Application For Variation Or Setting Aside Of Protection Order - South Africa
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REPUBLIC OF SOUTH AFRICA
FORM 12
[Regulation 13]
APPLICATION FOR VARIATION OR SETTING ASIDE OF PROTECTION ORDER
SECTION 10(1) OF THE DOMESTIC VIOLENCE ACT, 1998 (ACT NO. 116 OF 1998)
(A copy of this Form must be forwarded to the other party)
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 applicant)
1. PARTICULARS OF APPLICANT
Surname :
Full names :
Id.No / Date of birth :
Home or
temporary address :
Home/contact telephone
number :
Work address :
Work telephone number :
___________________________________________________________________
*Delete whichever is not applicable
Department of Justice and Constitutional Development
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