IN THE REGIONAL COURT FOR THE REGIONAL …

1 RC20 annexure B (REGULATION 3 OF THE MEDIATION IN CERTAIN DIVORCE MATTERS REGULATION, 1999) IN THE REGIONAL COURT FOR THE REGIONAL division OF gauteng HELD AT _____ CASE NUMBER: _____ IN THE MATTER BETWEEN:- _____ PLAINTIFF Identity Number:_____ AND _____ DEFENDANT Identity Number:_____ REQUEST TO FAMILY ADVOCATE TO INSTITUTE AN ENQUIRY IN TERMS OF SECTION 4 OF THE MEDIATION IN CERTAIN DIVORCE MATTERS ACT, 1987 (ACT OF 1987) 1. DETAILS OF APPLICANT REQUESTING ENQUIRY: FULL NAME: _____ RESIDENTIAL ADDRESS: _____ POSTAL ADDRESS: _____ TELEPHONE NUMBERS: (H/C)_____ (W)_____ 2. IS APPLICANT A PARTY TO AN ACTION / APPLICATION INVOLVING MINOR OR DEPENDENT CHILDREN: YES OR NO _____ 3. WHERE WAS THE ACTION / APPLICATION INSTITUTED LODGED: _____ 4. WHEN WAS THE ACTION / APPLICATION INSTITUTED LODGED: _____ 5. COURT FILE REFERENCE NUMBER OF ACTION / APPLICATION: _____ 6. NAMES, AGES AND GENDER OF MINOR OR DEPENDENT CHILDREN INVOLVED IN ACTION / APPLICATION: _____RC20 _____ 7.

2 DETAILS OF OTHER PARTY INVOLVED IN ACTION / APPLICATION: FULL NAME: _____ RESIDENTIAL ADDRESS: _____ POSTAL ADDRESS:_____ TELEPHONE NUMBERS :( H/C) _____ (W)_____ 8. FULL DETAILS OR REASONS WHY AN ENQUIRY IS REQUESTED: _____ 9. ARE YOU OR A MEMBER OF YOUR FAMILY KNOWN TO ANY WELFARE ORGANISATION OR AGENCY IF SO, STATE THE NAME OF THE ORGANISATION / AGENCY AND WHERE IT OPERATES: _____ _____ PLAINTIFF/ATTORNEY FOR PLAINTIFF ADDRESS:_____ TEL:_____ FAX:_____ REF:_____ TO: _____ DEFENDANT/ATTORNEY FOR DEFENDANT ADDRESS:_____ TEL:_____ FAX:_____ REF:_____ AND TO: THE OFFICE OF THE FAMILY ADVOCATE _____ _____ _____