Transcription of APPLICATION FOR AUTHORITY IN TERMS OF …
1 017-1235BI-196 APPLICATION FOR AUTHORITY IN TERMS OF SECTION 26 OF THE BIRTHS ANDDEATHS REGISTRATION ACT, 1992, TO ASSUME ANOTHER SURNAMEI hereby apply for AUTHORITY to assume the surnameand furnish the following reason for my APPLICATION ..PARTICULARS OF APPLICANT:Present surnameForenames in fullIdentity numberDate of birthPlace of birthPostal addressPostal codeTelephone numberTelephone codeI also wish to include in my APPLICATION my wife and minor children, whose particulars of birth are as follows:WIFE:Maiden nameIdentity numberForenames in fullCHILDREN:Forenames in full and surnameDate of birthPlace of birthIdentity number/Birth entry numberConsent of wife (if applicable).
2 Signature of applicant Signature of DEPARTMENTAL OF SOUTH AFRICADEPARTMENT OF HOME AFFAIRS
