I/We the undersigned*

Identity Number*

Born on*

in*

and*

Identity Number*

born on*

in*

do hereby make oath and say:

1.

**I/We **am/are **South African/***

**citizen/s and **am/are one of the same **person/s as appears from the

**photograph/s annexed hereto marked “A” and/or “B” initialled by me/us

on the reverse there for purposes of identification

2.

I/We am/are**

citizen/s, with a

permanent residence right in South Africa, permit  no.

Such permit is annexed hereto marked “C”

3.

**I/We are the **natural/adoptive parents

of*

who was born on*

at*

and is a **South African/*

citizen as will more fully appear from the copies of the annexed  abridged birth certificate marked “D” and/or order of adoption marked “E” and/or copy of his/her identity document/passport marked “F”.

4.

**I/We are not divorced nor separated nor is such divorce and/or separation pending;

OR

**I/We **am/are divorced and a copy of the consent paper granting me custody

of

is annexed hereto marked “G” and a copy of the **mother’s/father’s permission to the acknowledgement of **custody/paternity/maternity is annexed hereto marked “H”

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---------------------------------------------- (2)

Signed and sworn to before me at

And whose identity I’ve satisfied myself as to by reference to Annexures “A” and “B” hereto

---------------------------------

(COMMISSIONER OF OATHS)