(BI-1712A) Form 12 DEPARTMENT OF HOME AFFAIRS REPUBLIC

(BI-1712A) Form 12
DEPARTMENT OF HOME AFFAIRS
REPUBLIC OF SOUTH AFRICA
AFFIDAVIT IN RESPECT OF PARTIES TO PERMANENT SPOUSAL
RELATIONSHIP
[Section 7(1)(g) read with sections 11(6) and 26(b); Regulations 9(3)(b),
11(e), 22(3)(g) and 22(8)]
PART A: TO BE COMPLETED IN THE CASE OF INITIAL APPLICATION:
Particulars of citizen / permanent resident / foreigner on a temporary residence permit*
Surname …………………………….
Gender:
Male
Female
First name(s)
……………………………………………………………………………………………………
Residential address:
………………………………………………………………………………………………………..
Identity No.
or
Passport No. ………………… Nationality …………………. Date of birth ……………..........
Date of first entry into the Republic …………………….. Type of permit …………………….
Date of expiry of permit: ……………………………….
Particulars of foreigner
Surname ………………………………
Gender
Male
Female
First name(s)
…………………………………………………………………………..………………………….
Residential address:
………….……………………………………………………………………………………………
Passport No ………………………………………………………………………………………..
Date of birth ……………………………….. Place of birth ……………………………………..
Nationality ……………………… Date of first entry into South Africa ………………………...
Type of permit held ………………………………………………………………………………..
Date of expiry ………………………………………………………………………………………
I, ………………………………………………………… (first name(s) and surname)
being an *unmarried/divorced/widowed person and …………………………………
(first name(s) and surname) being an *unmarried/divorced/widowed person do
hereby *make oath and say/hereby solemnly affirm that we are parties to a
*homosexual/heterosexual spousal relationship for the past ………. years ………
months which is intended to be permanent and to the exclusion of any other
person from our relationship.
Our relationship involves cohabitation and a
reciprocal obligation to support one another emotionally and financially. Neither
of us are party to a marriage or spousal relationship with any other person.
To substantiate our relationship we attach documentation proving cohabitation
and the extent to which the related financial responsibilities are shared by us.
We are the parents of the following children:
Name of child Date of birth Name of mother of child Name of father of child
………………………………………………………
Signature of citizen or permanent or temporary residence permit holder
……………………………………………………….
Signature of foreign spouse
Thus signed and *sworn/solemnly affirmed before me on this …………. day of
………….20...
………………………………………………………
Commissioner of Oaths
First name(s): ………………………………………
OFFICE STAMP
Surname: ……………………………………………
Capacity: …………………………………………….
Place: ……………………………………………..
*Delete whichever is not applicable
PART B: TO BE COMPLETED IN ORDER TO DEMONSTRATE THAT THE
SPOUSAL RELATIONSHIP CONTINUES TO EXIST:
Particulars of *citizen/permanent resident/foreigner on a temporary residence permit
Surname …………………………….
Gender
Male
Female
First name(s): ………………………………………………………………………………………
Residential address: ………………………………………………………………………………
Identity No
or
Passport No …………………… Nationality …………………. Date of birth ………….……...
Date of first entry into the Republic …………………….. Type of permit …………………….
Date of expiry ………………………………………………………………………………………
Particulars of foreigner
Surname ………………………………
Gender
Male
Female
First name(s) …………………………………………………………………………..…………
Residential address : ………….…………………………………………………………………
Passport No ……………………………………………………………………………………….
Date of Birth ………………………………..Place of Birth ………………………
Nationality ………………………… Date of first entry into South Africa ……………………...
Type of permit held ………………………………………………………………………………..
Date of expiry ………………………………………………………………………………………
I, ………………………………………………………… (first name(s) and surname)
being an *unmarried/divorced/widowed person and …………………………………
(first name(s) and surname) being an *unmarried/divorced/widowed person do
hereby *make oath and say/hereby solemnly affirm that on …………………….
(date) we deposed to an affidavit confirming that we are parties to a spousal
relationship. We are not married and the spousal relationship mentioned in the
preceding paragraph still subsists with all the characteristics mentioned in Part A
of this Form.
We are the parents of the following children:
Name of child
Date of birth
Name of mother of child Name of father of child
………………………………………
………………………………………
Signature of spouse
Signature of spouse
Thus signed and *sworn/solemnly affirmed before me on this …………. day of
…………………… 20…
………………………………………………………
Commissioner of Oaths
First name(s): ……………………………………..
Surname: …………………………………………
Capacity: …………………………………………
Place: ……………………………………………..
*Delete whichever is not applicable
OFFICE STAMP