SURNAME MOTOR VEHICLE TRAILER NO.
OF PAGES REQUIRED: 5pg 10pg 25pg
(A NEW PAGE IS USED EVERY TIME YOU ENTER A COUNTRY)
FULL FIRST NAMES MOTORCYCLE CARAVAN
VALIDITY PERIOD REQUIRED:
MARITAL STATUS DATE OF BIRTH COUNTRY OF REGISTRATION
3 MONTHS 6 MONTHS 12 MONTHS
COUNTRY OF BIRTH LICENCE PLATE NUMBER
DEPARTURE DATE RETURN DATE
RESIDENT STATUS IN SOUTH AFRICA PERMANENT NONE YEAR OF MANUFACTURE
WILL VEHICLE RETURN TO SOUTH AFRICA/BOTSWANA/NAMIBIA?
ID NO. MASS / TARE (KG)
YES NO
PASSPORT NO. COUNTRY CURRENT VALUE R
HOME TELEPHONE NO. CHASSIS NO / VIN NUMBER
REFERENCES (RELATIVE OR FRIEND)
BUSINESS TELEPHONE NO. ENGINE NUMBER
CELLULAR NO. MAKE AND MODEL 1. NAME
EMAIL ADDRESS NO. OF CYLINDERS CELL
RESIDENTIAL ADDRESS HORSEPOWER (KW) 2. NAME
STYLE OR TYPE PICK-UP S/WAGON 4X4 CELL
CODE SEDAN MOTORCYCLE LDV
COLLECTION OF CARNET
OCCUPATION OR PROFESSION PETROL DIESEL
NAME OF EMPLOYER/BUSINESS COLOUR OF BODY COLLECTION NEEDS TO BE ARRANGED FROM OUR AA KYALAMI
OFFICE, ADDRESS AS FOLLOWS:
POSTAL ADDRESS UPHOLSTERY LEATHER CLOTH VINYL NO. 4 HYPERION ROAD, BARBEQUE DOWNS, KYALAMI, 1684
TEL: 011 7991040 / 1042
CODE NUMBER OF SEATS / BENCH
COUNTRIES YOU INTEND VISITING MAKE OF RADIO I, the undersigned, understand and agree to the conditions
(INDICATE WHICH COUNTRIES YOU WILL BE VISITING MORE THAN ONCE) under which the Carnet is issued, as per the declaration on this
NUMBER OF SPARE TYRES application. (See second page of this application)
SIGNATURE DATE
(OF THE APPLICANT)
SIGNATURE DATE
(OF THE APPLICANT)
