Annexure F - Application For A Project Linked Subsidy Page 3

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SECTION A: PERSONAL DETAILS
(To be completed by all applicants)
A “Spouse” is defined as a Husband, Wife or Long Term Partner
Married, living with long term partner or single with dependants
Period
Period
Period
Married*
Habitually Co-habiting with
Widow/Widower
long term partner*
with dependants*
Divorced with
Single with dependants*
dependants*
APPLICANT
SPOUSE
(or Deceased Partner)
Surname
Maiden or Former
Surname
Full Names
(First Three Only)
Identity Number
Gender
Male*
Female*
Male*
Female*
Race
African*
White*
African*
White*
Coloured*
Indian*
Coloured*
Indian*
Other*
Other*
If “other” specify:
Residential Address:
......................................................................................................................................................................................
.....................................................................................................................................………………..........................
......................................................................................................................................................................................
.........................................................................................................................................................……………….......
Disabled
Yes*
No*
If you or any of your dependants are disabled and you are applying for additional subsidy, please attach
original medical form (Appendix 1), duly completed and signed by your District Surgeon/Medical
Practitioner, registered with the Medical and Dental Council.
SECTION B: DETAILS OF DEPENDANTS (
Information on only 2 dependants to be supplied by applicant)
Surname
Initials
Relationship to Applicant
Age
Gender
Male*
Female*
If more than two dependants, provide total number of dependants
_________________________________________________________________________________________
NATIONAL HOUSING CODE: MARCH 2000: PART 3: CHAPTER 3: ANNEXURE F

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