AFFIDAVIT

Completed and signed affidavit to be faxed back to 086 637 2901 or emailed to mpfines@syntell.co.za

NOMINASIE VAN BESTUURDER OF PERSOON IN BEHEER / NOMINATION OF DRIVER OR PERSON IN CONTROL

Notice number: ____________________________

1) Ten tyde van die beweerde oortreding op die keersy hiervan was ek nie die
bestuurder of in beheer van die betrokke voertuig nie.
1) I was not the driver or in control of the vehicle at the time of the alleged
offence on the reverse side hereof.

2) Die voertuig was bestuur deur / onder beheer van:

2) The vehicle was driven by / under the control of:

Identiteitsnommer ________________________________________________________________ Identity number

Voorname ______________________________________________________________________ First Names

Van ______________________________________________________________________ Surname

Woonadres ______________________________________________________________________ Residential address

______________________________________________________________________

______________________________________________________________________

Poskode ___________________________________________________________ Postal Code

Posadres (indien verskillend van woonadres) Postal address

(if different from residential)
______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Poskode ______________________________________________________________________ Postal Code

Telefoonkode en nommer __________________________________________________________ Telephone code and number

Faks kode en nommer _____________________________________________________________ Fax code and number

3) Ek verklaar dat die bogenoemde besonderhede waar en korrek is en aanvaar dat

'n valse verklaring strafbaar is met 'n boete of tronkstraf of beide.
3) I declare that the above particulars are true and correct and accept that a false declaration
is punishable by a fine or imprisonment or both.

Naam van geaddresseerde Kontak nommer van geaddreseerde

Name of Addressee Contact number of addressee

____________________________ ___________________________

Handtekening van geadresseerde Datum

Signature of addressee Date

____________________________ ___________________________
DD MM YYYY

BELANGRIKE INLIGTING ADDITIONAL INFORMATION

1. Die voertuig is gefotografeer terwyl die beweerde oortreding plaasgevind het.
2. Weens die hoek waaruit die foto geneem word, kan die insittendes van die voertuig
meestal nie uitgeken word nie.
3. Ingevolge die bepalings van artikel 73 van die Nasionale Padverkeerswet (Wet 93
van 1996), word daar veronderstel dat die voertuigeienaar die voertuig bestuur het,
tensy die teendeel bewys kan word.
1. A photograph was taken of the vehicle while the alleged offence occurred.
2. Because of the angle of the photograph, it is usually not possible to identify
the occupants of the vehicle.
3. In terms of the provisions of section 73 of the National Road Traffic Act (Act
93 of 1996), it shall be presumed, in the absence of evidence to the contrary,
that such vehicle was driven by the owner thereof.

4. Let wel - Indien 'n tjek deur die bank geweier word, sal die uitreiker van die tjek
aanspreeklik wees vir die gevolglike regs- en bankkoste.
5. Indien u nie die voertuig bestuur het tydens die beweerde oortreding nie, voltooi die
vereistes van Nominasie van Bestuurder of Persoon in Beheer afdeling hierbo en stuur
hierdie vorm terug.
4. Note - If a cheque is dishonoured by the bank, the issuer of the cheque will
be liable for the legal and bank costs arising there from.
5. If you were not the driver or in control of the vehicle at the time of alleged
offence. Complete the requirements of the Nomination of Driver or Person in
Control section above and return this form.