Form 10 - Affidavit Regarding Contravention Of Protection Order - Republic Of South Africa
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REPUBLIC OF SOUTH AFRICA
FORM 10
[Regulation 11]
AFFIDAVIT REGARDING CONTRAVENTION OF PROTECTION ORDER
SECTION 8(4) OF THE DOMESTIC VIOLENCE ACT, 1998 (ACT NO. 116 OF 1998)
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 :
2. PARTICULARS OF PROTECTION ORDER
A protection order was granted and a
warrant of arrest authorised on :
(Date)
In the Magistrate’s Court at :
Against :
(Name of Respondent)
A copy of the Protection Order (indicating what orders were made), and the original warrant of
arrest are attached.
Department of Justice and Constitutional Development
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