0 ratings0% found this document useful (0 votes) 192 views2 pagesDha-529 South Africa Citizenship Form
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REPUBLIC OF SOUTH AFRICA,
DEPARTMENT OF HOME AFFAIRS.
DETERMINATION OF CITIZENSHIP STATUS
INFORMATION TO BE FURNISHED IN FULL IN ORDER TO ASSIST IN DETERMINING YOUR CITIZENSHIP UNDER THE
SOUTH AFRICAN CITIZENSHIP ACT, 1995 (ACT
A
a
4
6
2.
1",
2.
(OF 1995), WHICH CAME INTO OPERATION ON 6 OCTOBER 1995
PERSONAL PARTICULARS.
SURNAME 2. MAIDEN NAME
FORENAMES (nf. -
DATE OF BIRTH 5. PLACE OF BIRTH
IDENTITY NUWBER
bom outside South Ata, please state—
{a} Dato.on whieh you test entree Scutn Aiea for pemanant residence
(b), The ports) (dates) of your residence in South Aca
(©). Number ot mmigraton port an dat o sue .
(©) Numberof cerita of nauaisaton and date of sue
Irom in Namibia, please state your pormarent asiontal adres at on 1900-09-21
Ifyou were absent rom South Aca siate—
(a) Dato() of your separa
(8) Roason(s) for your departure E
(1 Tha date on which you rtumelto Sou Aries permanent
(id you renounce yeu South Atican cizenship? VESINO,
YES, the dete on wrich the renunelaton was agstered
Partclars in respect of foreign ctzonship:
(2) Chizenstip acquies (cour) (2) Dato an pace of acquisition, =
(Means of scquistton of foreign ctizenshi, Le. mariage, ratuaisaton, descert cr registration? (Please attach copyraot
nero. cs “
(6) Did you apa fr the retentioniesnstatement of South Aficen citzenship? YESNO. YES, atlach a cooy ofthe relevant cereal
Data of marago of your parents 18, Place of mariago of your parets
MARITAL STATUS
Please tush he following particulars in respect ot your spouse
le) SURNAME. (0) MAIDEN NAME...
(0) FORENANES (nf
(6) DATE OF BIRTH, = _ (6) PLACE OF BIRTH, a
(f) IDENTITY NUMBER OF YOUR SPOUSE I
(@) Ome on whieh heise
14 South Aiea forthe fst timo for permanent resisonc.
(Petal) (tes) of residence in South Aca ih
(Baie ot yeur mariage Place, H
(i) apical, the date of your husband's death or your dverce
(Nationality of you spas. 2 pawn
FATHER'S PARTICULARS. 21528
SURNAME,
FORENAMES (in fu)
DATE OF BIRTH. 4, PLACE OF BIRTH, a
IDENTITY NUMBER
(a). tthe was bam outside South Are, the dato on which he erred South Arica fer st Une for permanent eeidence:
(6) Perio) (dates f his residence in Sout Aa. ote a
(1 Number of imitation permit and date of sue o
(@)_ Number of contete of natwakseton and date of issue
Pariculars in respect of frsigncszenship
(a) ciizenship acquis (county) (©) Dato an place o acquision,
(©). Moans o fora appeaton, Lo. mariage, natrateaion,cascont or roisvaton?
ha was absent rom South Aticastate—
(2) Dato) of is departure 4 a
(b)_ Reason) fortis depart. =
[e)_ Date on whic he retuned to South Alea permanant =
Did he renounce hie South African ctizenshie? YESINO.
IVES, the data on which the renunclaton was regstered
OTHER'S PARTICULARS
SURNAME 2. MAIDEN NAME,
FORENAMES (in,
DATE OF BIRTH 5. PLACE OF BIATH..
commer [TTT TTT ITT IT)
(a). she was bom outside Suh rc, the date on which ae entered South Aca forthe fst tine for permanent esdence
(0) Perio) (dates f her resin n Sout Aca
(Number of mmrsion permt ana cate ot ue
(8) Numer of confeate of naturalsaton and dete of sue
Parteuars in vspect of frogn otzonshe
(2) Chizership acquires county) (6) Date and pace of eequiston
(Whats hor claim to ciizansip, Le. mariage, natuaiastion,descont or regsaion? i
It she was absent from South Aires state—
(a) Date(s) of her departure — coma
(0) Reason) fr ner departure
(©). Date on whic she ested to South Aca permanently
(id she renounce her South Afcanetzensnin? YESINO.
IES, the dt on whch the renunciation was regitore. - a ie
(CERTIFIED THAT THE INFORMATION FURNISHED ABOVE IS CORRECT
Dare. SIGNATURE iF Ep
ADDRESS on
POSTAL CODE.
TELEPHONE NUMBER,
