Declaration to confirm Address for Company

I the undersigned
Full names: ____________________________________________________________

Identity Number: ___________________________________________ (Copy of ID annexed

hereto and marked Annexure “A”)

Do hereby declare;

1 That I am residing at

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
(Residential address)

2 That the following company trades from my residential address stated above
___________________________________________________________________
(Name of company)

3 I have produced an original ______________________________

(Description of document annexed hereto and marked Annexure “B” – which is your own proof of
address document to attach)

(e.g. Water & Electricity Account, Bank Statement, SARS Registration Doc, Rental Invoice etc.)

Signed at____________________________on the ______day of_____________ 2022, in

the presence of the undersigned witnesses.

_________________________________
Signature of Deponent