cesar ise REPUBLIC OF SOUTH AFRICA, DEPARTMENT OF HOME AFFAIRS. DETERMINATION OF CITIZENSHIP STATUS INFORMATION TO BE FURNISHED IN FULL IN ORDER TO ASSIST IN DETERMINING YOUR CITIZENSHIP UNDER THE SOUTH AFRICAN CITIZENSHIP ACT, 1995 (ACT A a 4 6 2. 1", 2. (OF 1995), WHICH CAME INTO OPERATION ON 6 OCTOBER 1995 PERSONAL PARTICULARS. SURNAME 2. MAIDEN NAME FORENAMES (nf. - DATE OF BIRTH 5. PLACE OF BIRTH IDENTITY NUWBER bom outside South Ata, please state— {a} Dato.on whieh you test entree Scutn Aiea for pemanant residence (b), The ports) (dates) of your residence in South Aca (©). Number ot mmigraton port an dat o sue . (©) Numberof cerita of nauaisaton and date of sue Irom in Namibia, please state your pormarent asiontal adres at on 1900-09-21 Ifyou were absent rom South Aca siate— (a) Dato() of your separa (8) Roason(s) for your departure E (1 Tha date on which you rtumelto Sou Aries permanent (id you renounce yeu South Atican cizenship? VESINO, YES, the dete on wrich the renunelaton was agstered Partclars in respect of foreign ctzonship: (2) Chizenstip acquies (cour) (2) Dato an pace of acquisition, = (Means of scquistton of foreign ctizenshi, Le. mariage, ratuaisaton, descert cr registration? (Please attach copyraot nero. cs “ (6) Did you apa fr the retentioniesnstatement of South Aficen citzenship? YESNO. YES, atlach a cooy ofthe relevant cereal Data of marago of your parents 18, Place of mariago of your parets MARITAL STATUS Please tush he following particulars in respect ot your spouse le) SURNAME. (0) MAIDEN NAME... (0) FORENANES (nf (6) DATE OF BIRTH, = _ (6) PLACE OF BIRTH, a (f) IDENTITY NUMBER OF YOUR SPOUSE I (@) Ome on whieh heise 14 South Aiea forthe fst timo for permanent resisonc. (Petal) (tes) of residence in South Aca ih (Baie ot yeur mariage Place, H (i) apical, the date of your husband's death or your dverce (Nationality of you spas. 2pawn FATHER'S PARTICULARS. 21528 SURNAME, FORENAMES (in fu) DATE OF BIRTH. 4, PLACE OF BIRTH, a IDENTITY NUMBER (a). tthe was bam outside South Are, the dato on which he erred South Arica fer st Une for permanent eeidence: (6) Perio) (dates f his residence in Sout Aa. ote a (1 Number of imitation permit and date of sue o (@)_ Number of contete of natwakseton and date of issue Pariculars in respect of frsigncszenship (a) ciizenship acquis (county) (©) Dato an place o acquision, (©). Moans o fora appeaton, Lo. mariage, natrateaion,cascont or roisvaton? ha was absent rom South Aticastate— (2) Dato) of is departure 4 a (b)_ Reason) fortis depart. = [e)_ Date on whic he retuned to South Alea permanant = Did he renounce hie South African ctizenshie? YESINO. IVES, the data on which the renunclaton was regstered OTHER'S PARTICULARS SURNAME 2. MAIDEN NAME, FORENAMES (in, DATE OF BIRTH 5. PLACE OF BIATH.. commer [TTT TTT ITT IT) (a). she was bom outside Suh rc, the date on which ae entered South Aca forthe fst tine for permanent esdence (0) Perio) (dates f her resin n Sout Aca (Number of mmrsion permt ana cate ot ue (8) Numer of confeate of naturalsaton and dete of sue Parteuars in vspect of frogn otzonshe (2) Chizership acquires county) (6) Date and pace of eequiston (Whats hor claim to ciizansip, Le. mariage, natuaiastion,descont or regsaion? i It she was absent from South Aires state— (a) Date(s) of her departure — coma (0) Reason) fr ner departure (©). Date on whic she ested to South Aca permanently (id she renounce her South Afcanetzensnin? YESINO. IES, the dt on whch the renunciation was regitore. - a ie (CERTIFIED THAT THE INFORMATION FURNISHED ABOVE IS CORRECT Dare. SIGNATURE iF Ep ADDRESS on POSTAL CODE. TELEPHONE NUMBER,