Client Surname & Initial(s) Tel no E-mail address

1 1 Client Surname & initial (s) Tel noE-mail address Proof of payment : Payment to be made to the following account :RCH Legal Cheque AccountFNB GeorgeAcc no : 62474621177 Branch code : 210114 DOCUMENTS TO BE ATTACHED _____ ID: Copy of ID documentsCertificates : Copy of marriage certificate and birth certificates of minor children Statistics form Completed statistics form Annexure A : Only where minor children are involved Lexpro |054| DIVORCE QUESTIONAIRE 1. The Plaintiff is with residential address at and work address at 2. The Defendant is with residential address at and work address at 3. The parties hereto were married in / out of community of property with/without accrual on and at and this marriage still subsists. (Kindly attach copy of marriage certificate and antenuptual contract if any) 4.

2 From the marriage between the parties child(ren) were born, namely (names and birth dates) : Lexpro |054| 5 It shall be in the best interest of the minor children that the custody and control be awarded to . 6. The marriage relationship between the parties has reached such a state of disintegration, that there exists no reasonable prospect of the restoration of a normal marriage relationship between them, for the following reasons (please mark which applicable): There is no communication between the parties, and the parties can no longer get along with each other; The defendant is unreasonably jealous towards the plaintiff; The defendant unjustly accuses the plaintiff of relationships with third parties; The defendant has started a love relationship with another man/ woman; The parties have on several occasions experienced trouble with their marriage and tried to restore the relationship, without success; For the past few years the parties could not adjust to each others needs and experienced conflict of interest.

3 The personalities and the way of living of the parties cannot adjust to each other, since they follow different occupations; The defendant regularly quarrels with the plaintiff s family in a manner that is unreasonable and unacceptable to the plaintiff; The plaintiff and defendant do not cohabit as husband and wife anymore; The defendant is grumpy and quarrelsome towards the plaintiff; Lexpro |054| There is no meaningful communication between the parties, and they quarrel regularly; The defendant is excessively aggressive towards the child(ren); The defendant regularly drinks excessively in front of the plaintiff and their child(ren); The defendant becomes aggressive and violent towards plaintiff and the child(ren), especially when under the influence; The defendant gets fits of fury towards the plaintiff; The defendant has assaulted the plaintiff on a previous occasion; The defendant has chased the plaintiff away from the common home; The Defendant refuses the Plaintiff his/ her marital privileges on a regular basis; There was continuous arguments between the parties on politics, religion and money; The Plaintiff tried to persuade the Defendant to move back into the common home, to resume the marriage relationship and to attempt reconciliation.

4 The Defendant refused to co-operate; the Defendant became physically cold and aloof towards the Plaintiff; The Plaintiff has lost his love, respect and affection for the Defendant; The parties are no longer interested in the continuation of the marriage relationship. 7. The communal property currently consists out of: Lexpro |054| The plaintiff is currently in possession of the following movable assets to which he/ she is not the owner, and to which he/ she has no right of possession: WHEREFORE the Plaintiff claims: a. A decree of divorce; b. Division of the communal property, including division of the defendant s pension and policies; c. An order that the parental rights and duties regarding the daily care of the minor children, as stipulated in Section 18(2)(a) of The Children s Act 38 of 2005 (hereinafter called the Act ), shall vest in the (state party); d.

5 An order stating that the permanent residence of the minor children shall vest in the (state party); e. An order stating that certain parental rights and duties regarding contact with and access to the minor children, as stipulated in Section 18(2)(b) of the Act, shall vest in the (state party) as follows: (visits) Lexpro |054| (i) f. The parental rights and duties with regards to guardianship over the minor children, as referred to in Section 18(2)(c) and 18(3) of the Act, are awarded to both parties jointly, which implies that all decisions regarding the minor children must have both parties approval. g. Maintenance in the amount of monthly per minor child; h. Maintenance towards the plaintiff/defendant in the amount of ; i. An order that the plaintiff is entitled to payment by the defendant of an amount that is equal to half the difference between the accrual of the plaintiff and defendant s estate; j.

6 Cost of the suit, only if defended; k. Further and/ or alternative relief. ( * Delete where not applicable) RC19 1 ANNEXURE A (REGULATION 2 OF THE MEDIATION IN CERTAIN DIVORCE MATTERS REGULATIONS, 1990) 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: _____ ARRANGEMENTS REGARDING DEPENDENT AND MINOR CHILDREN PARTICULARS OF PLAINTIFF/APPLICANT: POSTAL address : _____ _____ _____ _____ RESIDENTIAL address : _____ _____ _____ _____ TELEPHONE NUMBER: _____ NAME AND address OF EMPLOYER: _____ _____ _____ _____ TELEPHONE NUMBER: _____ GROSS MONTHLY INCOME: _____ EXTENT OF MONTHLY FINANCIAL COMMITMENTS: ( * Delete where not applicable) RC19 2 _____ PARTICULARS OF DEFENDANT/RESPONDENT: POSTAL address : _____ _____ _____ _____ RESIDENTIAL address : _____ _____ _____ _____ TELEPHONE NUMBER: _____ NAME AND address OF EMPLOYER: _____ TELEPHONE NUMBER: _____ GROSS MONTHLY INCOME, IF KNOWN: _____ EXTENT OF MONTHLY FINANCIAL COMMITMENTS, IF KNOWN: _____ GENERAL INFORMATION STATE THE FULL NAME, GENDER AND DATE OF BIRTH OF EACH MINOR OR DEPENDANT CHILD OF THE MARRIAGE: _____ STATE WITH WHOM THE CHILDREN ARE LIVING AT PRESENT: _____ STATE WHERE THE CHILDREN ARE TO LIVE, FURNISH PARTICULARS OF THE ACCOMODATION, WHAT ( * Delete where not applicable) RC19 3 OTHER PERSONS (NAME THEM) ARE LIVING THERE AND WHO WILL LOOK AFTER THE CHILDREN.

7 IF IT IS PROPOSED THAT THE CHILDREN SHOULD BE IN THE CARE OF ANOTHER PERSON OTHER THAN YOU, STATE THE RELATIONSHIP OF SUCH OTHER PERSON TO THE CHILDREN? _____ _____ STATE THE NAME OF THE SCHOOL OR OTHER EDUCATIONAL ESTABLISHMENT WHICH YOUR CHILDREN ARE AT PRESENT ATTENDING, OR, IF ANY OF THEM ARE ALREADY WORKING, THEIR PLACE OF EMPLOYMENT, THE NATURE OF THEIR WORK AND DETAILS OF ANY TRAINING THEY ARE RECEIVING, ATTACH COPIES OF THE MOST RECENT SCHOOL REPORTS: _____ IS IT ENVISAGED THAT THE CHILDREN, AFTER THE CONCLUSION OF THE ACTION/ APPLICATION, WILL HAVE TO CHANGE SCHOOLS? IF SO, GIVE FULL DETAILS: _____ DO ANY OF THE CHILDREN EXPERIENCE LEARNING PROBLEMS? ARE ANY OF THEM IN ANY RESPECT PHYSICALLY OR MENTALLY DISABLED? IF SO, GIVE FULL DETAILS AND ATTACH RECENT MEDICAL REPORTS. _____ STATE WHO IS SUPPORTING THE CHILDREN AT PRESENT, OR CONTRIBUTING TO THEIR SUPPORT, AND TO WHAT EXTENT?

8 _____ ( * Delete where not applicable) RC19 4 WHAT ARRANGEMENTS HAVE BEEN MADE REGARDING RIGHTS OF ACCESS OF YOUR HUSBAND/WIFE? STATE THE DETAILS OF ANY SUCH ARRANGEMENT? _____ SET OUT ANY FURTHER DETAILS CONCERNING YOUR MINOR OR DEPENDANT CHILDREN WHICH MAY BE RELEVANT TO THE CUSTODY OF, ACCESS TO AND FINANCIAL PROVISION FOR SUCH CHILDREN, WHETHER ANY SUCH CHILDREN HAVE BEEN CONVICTED OF ANY CRIMINAL OFFENCE WHETHER ANY SUCH CHILDREN HAVE BEEN SUBJECT TO ANY ORDER IN TERMS OF THE CHILD ACT, 1983 (ACT NO 74 OF 1983): _____ STATE BRIEFLY THE EXTENT TO WHICH THE ABOVE ARRANGEMENTS REGARDING YOUR MINOR OR DEPENDANT CHILDREN ARE THE RESULT OF MUTUAL AGREEMANT WITH YOUR HUSBAND/WIFE/SPOUSE? _____ ARE YOU OR A MEMBER OF YOUR FAMILY KNOWN TO A WELFARE ORGANISATION OR AGENCY? IF SO, STATE THE NAME OF THE ORGANISATION/AGENCY AND WHERE IT OPERATES. _____ I, _____ HEREBY DECLARE UNDER OATH/HEREBY TRULY AFFIRM THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE FOREGOING STATEMENTS ARE TRUE, COMPLETE AND CORRECT.

9 ( * Delete where not applicable) RC19 5 DATED AT _____ THIS _____ DAY OF _____ 20_____. _____ SIGNED I certify that, before administering the oath/affirmation*, I asked the deponent the following questions and wrote his/her answers in his/her presence: 1. Do you know and understand the contents of the above declaration? Answer: _____ 2. Do you have any objection to taking the prescribed oath? Answer: _____ 3. Do you consider the prescribed oath to be binding on your conscience? Answer: _____ I certify that the deponent has acknowledged that he/she* knows and understands the contents of this declaration which was sworn to/affirmed before* me, and the deponent s signature/thumb print/mark* was placed thereon in my presence. _____ JUSTICE OF THE PEACE/COMMISSIONER OF OATHS* FULL NAME: Surname : BUSINESS address : DATE: STATISTICS OF DIVORCES CASE NO. FORM 07-04 EXPLANATORY NOTES: Implementation date: 03/05/99 SECTIONS 1 - 4 TO BE COMPLETED FOR BOTH HUSBAND AND WIFE.

10 SECTIONS 5 - 10 TO BE COMPLETED BY THE PLAINTIFF. Husband Wife 1. IDENTITY Name and Surname Current address (or last known address ) Identity number Population group1 Occupation at time of divorce Plaintiff 1 .. African/Black Coloured Indian/Asian White Other (Specify):.. Husband .. African/Black Coloured Indian/Asian White Other (Specify):.. Wife 2. MARITAL STATUS AT TIME OF MARRIAGE 1 Never Widower Divorcee Married married Never Widow Divorcee married 3.