ersoneae Bht7ae DEPARTMENT: HOME AFFAIRS REPUBLIC OF SOUTH AFRICA APPLICATION FOR TEMPORARY RESIDENCE PERMIT [Sections 10 (2; Regulation 7(1) (an (CATEGORY OF PERMIT BEING APPLIED FOR Work: Quota Work: General ‘Own business tnre-company wansier Corporate worker Exceptional okie ‘Study @ 9 months) Medical > 3 months) Rotatve’s tired person Student exchange programme | | Work exchange programme ‘Cutralieconomi/socil ‘exchange programme Toaty ‘Ofice of origin BtOK: ‘iesion tie No Date rseived Dato forwarded to Rogional Otc: ‘Submisslon checked bylon Date received at Regionall Ramarks Otice: PaRSDOT SoanTaRUTIOG BVT Focommended byiar Foo: Carrey and amount proved bya Fa vacaived bya Daaision conveyed bylonbar Facoiat No. Teter] Facamnie | Other Foasons for decision:1._PERSONAL DETAILS Tie: we [me | Other ect) ‘Sara Fay wae ‘Gren marae Taian a Sage ar PissT ahaa raya aaoe reed Soa Date ofits You Month Dayan Place of it Town. se County Marta tate: Never maried Separated Lega ecogrised spousal latonship Marios Widowed Biv Ccusemary unen | separated stat: etna vores sroceengs have ben insted and when final dete is expats 7 Taivoreed, provide: cre oder must be stachad, i rariod 6a ezn ora paranect rondo, ceied copy ofthe marrage cacte muse tached 2._ CITIZENSHIP DETAILS Present county of eizenship acquired eter an by bith, ale and coro unr wid 6o9are Do youd any otter tizansip? Nol] vee 1s, ot wich county, ps deta ss 3._ PASSPORT DETAILS Passport nab ‘Coury of ssu6 ‘ate of eve 7 i Val nt 7 n ifyeu Rave any aor document rqued by you Governor, onde Stale ‘ype of docunen. Numbee sy cate L ADDRESSES: siden aaarona= Postal adronsr Postal code. Postal code... ‘Coin of viel siden Hater fan hy of ogi atom re “leghane numbers: Wort: (re coe ) Home: (are code ) =‘ter adresses where you have ved dwing the lel tn yore other than your curet address: ‘ees Petod | Covey ‘De you hol he rghit of re-enry into your county of eign and/or country of eslence Wha Gera?™ [ Have you ever apted Tor avium or refugee satus in SA or any oer country? eld» Ld fe . . _ aa Rettonship: Feet [| Romane aesacaio || etre [ [Over —— : . . sao aa etal regnaing relatives andor Wanda In South Aron Wany: Name ‘aera Relators | ___ 10 Wo 5,_INTENTIONS/PROPOSED DURATION OF STAY IN THE REPUBLIC Proposed date and place of departure for South Aca: am ‘Acie ave ana place ot rival n South Arc: 7 Treating by Ale Road a see] | Carr "yu tend saying Sou ia tomporary ony sate your propos vation fay. Dayeweotsinntao "ear [nodes to epee 77 you ron ating Sout Aca on a permanent bass? | Wa, Rave you Sed a pico oa Poa Te dence pare “CC «fC wef] wf ye and te eo i el apsion bod p os {oorelgn/omesc ofca under Retornce No ‘utne your proposed actives whit n the REPUBLI:6 MAINTENANCE/DEPORTATION State what funds you have avaliable for mlntonance during your say In South Aca and whether you have purchased a ratur chat or other arangerenta made fr maintenance and return passage: "Albi fund foregn curenay TYP ——— ‘mount SSARand equivalent. a _Atached bank sislomerts 2s post ot und hl ‘Val ret a ward tek number: iin dat 7 7 {cash deposit inthe amount of. 7_PARTICULARS OF ANY FAMILY/DEPENDANTS ACCOMPANYING YOU oo Dadi Sib [Prem | Sa | Tay Cae aa Sahakari me? — [oo [We [ae — 7 Tipeme Tear maa ent [We [we] | Ss nce ZZ i your poe andor er dependants are no acsorerving yo, tay nnd ere the cour a alr age? ves [—] Ontéas) [ | No [7] batashoaso '&._ PREVIOUS APPLICATIONS. ave you or any ober person Inldea this eppleaton revovalyappled Torey Wpe of South Alan vs, or exert from va cont, btaied temporary resience parts on arta? No Yee (Ge tal of each aplton: Tenecow geno T T vane assists” | oxtand pon of "aH Pe ot ppteton Detlef ary por resco depotatons/ordes wo depart om South Aiea:9. SECURITY/MEALTH QUESTIONNAIRE esr ys ee eng cae eo "tl ca ait a wl ona eG ~O Shimmer) ‘iw youan woot echt? wel] » CII Have you ever been ually declared incompetent? ves] vo [ SRR cee ww Furi a pariculs h reply to any of these cussions ie nha 10._ ANY ADDITIONAL INFORMATION YOU WISH TO BRING TO THE DEPARTMENT'S ATTENTION: 11,_ DECLARATION BY APPLICANT | acknowledge that | understand the contents and implications of this application and solemnly declare that the above particulars given by me as wall as all particulars in the attached ‘supporting documentation are true and correct, ‘Sigiatire oF applicant iii‘THE FOLLOWING ORIGINAL SUPPORTING DOCUMENTS MUST ACCOMPANY THE APPLICATION: Part A |n respect ofall permit applications, except medical treatment permite: ‘Attached Yeo No Passport valid for no less than 30 days afer expiry ofthe intended vis, ‘A modial cortioate, A raologica repor. Full bith certfcat in respect of each dependent cil ‘Marriage carificate orn the case ofa loelgn apousal relationship, proof of offical recognition thereot ised by the authorities of the foreign county ofthe applleant (ohare appicabl). “The affidavit where a spousal relationship to @ South Afican citizen or residnt is _aolicable as wel as documentation roving cohabitation and the extant to which the related financial responsbilties are shared by the pares and setting out the particulars of citren inthe spousal relationship. Proof ofa union recognised in terms ofthe Recognition of Customary Marriages ‘Act, 1986 (Act No. 120 of 1998), where applicable. Divorce decree, where applicable Proof of court order awarding custody, where applicable | Death conticate, in respec of late spouse, where applicable ‘Witten consent from both parents, or sole custody parent where applicable with root of sole custody. root of laga adoption where appicabe. ‘Legal separation order, where appicabe. Police clearance cetficates in respect of applicants 18 years and ode, In respect of all counties where person resided one Yea or longer. ‘A vaccination cortical required by the Act “an official eter from the relevant Instiuion confining provisional aoceplance at that Inston and the duration of the course, Inthe case ofa minor (Le. @ person under 21), witen permission by both parents ‘or sole custody parent: Provided that relevant documentation proving sole custody ‘The particulars ofthe person(s) in the Republic who wil act a the minor eamer's (uardian and a confirmatory eter rom the intended guardian. Proof of @ medical cover recognised in the Republic. root of sufficient funds to cover tution fees, subsistence and inidertal costs. Part In respect of a business permit to establish en own business orto Invest in an exlating business venture: CCerttication by a chartered accountant that at least R2 millon in cash or @ cap- ital contbution of at least R2,5 milion ofa combination of cash and a captalcon- tribution amounting to R2.§ millon avaiable. ‘Abusiness plan outining the feasibly of the business.‘tached Yeo Wo Proof or undertaking that at least five cizens or permanent residens wil be permanenty empoyed. \Whore the application isin respect ofan investment in an existing business; wrt- ton pariner agreements containing ful deals of tho partnrsidrectors and thoir residential statue nthe Republic, Documentation proving the investment by means of shareholders or patnership agreements, fan existing business. ‘Undertaking 10 register wih appropriate sation Body, requred by the nature oF the business. Vite an existing business, nancial eatements proving Vbiiy of the business ‘An undertaking to register withthe South Aican Revenue Services. Pert D In respect of a medical treatment permit: ‘Pariculare of and prot of francil means to cover day to day neods ol persons ‘seeempanying meatal prmit elder, lary nthe orm of bank latoments, salary ‘vices, avaliable, or travels cheques, “Aletar fom the applicant's medical practioner or medical insttuton,inloaing ~] the reasons for veatment, the period of treatment and parteulars of tho Weatment in the Republi. ‘Apasspot valid for no less than 30 days after expr ofthe Intended visit Particulars of persons auvompanying such pert holder, any. Part ‘Attached In respect of a quota work permit: Yeo We Proof ofthe rlevant qualifications as coed by the South Aican Qualfeations ‘Authoiy including auuhencated copes of scademie ceiicaione of dogroes, Proof of registration with professional dy, board or cual, ppc Proof of previous experience inthe occupation Part F In reapect of a general work perm ‘etter of motivation from the employer why a ciizen/resident could not fill he Poalen, accompariad by documontaryproot of eos made to oblate ee¥ices fa olizen oF resident Particulars of unsuccesstl candigates root of qualiteations evaluated by the South Afican Qualifications Author Proof of registration with the professional body or boar if applicable, root of experiance and sein ne withthe Job ofr. “The employer {0 submit a certiicaton from the Department of Labour or an ‘extraction from the databese of e salary benchmarking organisation detaling the erage salary earned by employees fling similar postbons inthe Republi.Pata In reapect of an exceptional sills work permit: ‘Attached Yes No. ’A comprehensive curicuum viae together with tesimonials fom previous employers. “ota rom a foreign or South Afioan organ of lato, or om an eataiahed South ‘Aircan academe, eutural or business body, confiring the applicant's excepton- al sls or qualifications ‘Any cther proof to substantiate exceptional sila oF qualifations, euch ee publ catlons and testimonials Completion ofthe relevant secons of the applicaon form by the prospective ‘employer, already in possession ofa jab ofter ‘Aleta of matvaton indicating that the exceptional skills possossed by tho appl- ‘cant wit tothe Benet of he South Amnean environment in which ne ot she intends to operate Pant {mn respect of an intra-company transfer work permit: Foreigne's contract of employment wth a company abroad tier rom the company abroad thatthe applicant shal be wansfored to a branch of thet company oF an afilated company stuated in South Afric ‘South Atcan company confining the wansfer trom the parent or allaled ‘company abroad as well as speciying the occupation and capacty in which the foreigner shal be employed, and tal the maximum duration wil not exceed two yours. Patt In rospect of a work Issued interme of a corporate permit: ‘Acorporate worker authorisation caticae trom the employer. ‘Avalid employment contact. Part J In respect ofa retired person permit: Proof of a pension fund or an revocable raiment annully or a net wort or a ‘combination of assets reaising a minimum amount of R20 000 per month per retired person PantK |n respect ofa learning inetitution In the Republic in conjunction witha foreign learning. Institution or ‘organ ofa foreign state organising or adminietering the exchange programme: ‘A letter fom the Deparment of Education or the learning ination ia the Repubic, confirming that It Is responsible for organising oF administering the ‘programme outining the activities and duration thereot, as well as confirming tat [wil ake ful responsbity forthe student wrt he or she sin the Republi ‘A eter ftom the organ or earring insttuton ofthe foreign state, config the Dartculars of the student, the students envotnent with @ leaning insthuion ‘abroad, as wel asthe date on which study shall commence. Part In respect of on organ_of stato in conjunction with s foreign learning inettution or an organ ofa foreign ‘State organising or administering the exchange programme: TA letor from the organ of stale confeming the enletonoe of Uw exchange programme. ‘A lator from the foreign leaming instuton confirming the enclment of the ppc’ oa ei rom he organo the frig Sa conding te program ‘abt caso mayPart M In respect of an exchange permit: ‘Attached You No (Offer of employment dealing te terms, conditions and duration ofthe intended ‘employment and certtying that the applicants remuneration will comply wit ‘applicable legal requirements and the employer's undertaking o provide forthe wotre and needs ofthe applicant. Part N In respect ofa treaty permit: ‘letter rom the relevant organ of state attesting to the nature ofthe programme and the realy under which it is conducted: = the fact thatthe relevant foreigner partcpates in such programme, = the type of activites which te foreigner Is expected to perform under ‘such programme; and the duration ofthe programme, Pato In respect of a relative’s permit: root that foreigner is ]@ momber ofthe Immediate family ofthe sponsoring cian of permanent resident. roof by means of salary advice or bank statement thatthe sponsoring ctizen oF permanent resident has FS 000 per month per person, which amount shall not ‘ply inthe case of @ spouse or minor child of ho cizah or permanent resident Part P In respect of an application for a work permit ‘Tis part must be completog by the employer anc submited by tne applicant wan at otner requrea documents Separaio sheets may be attached if tho space provided is ineulent to include ful Information or motivation, Otter of employment for al work permit: ‘Name of company/erganisation: Phyaical adaroas: | Postal adaross: "Telaphone number (ode) number) Facsimile number: (code) (number) Employer’ business registration number Employers tax reference numibor ‘Wa subsidiary alve name of principal company, nature of business Conducted and location: ‘Number af emoloveen: Key category porting, | Management | Professional | Clerical Unkle ‘South African eltizens Permanent residents Holders of temporary work permits I ‘The positon olfered has been vacant since: Ta newly crealed postion, provide deta “The postion was brought to he attention of the applicant in the folowing manner:FRecrultment and interviewing of citizens or permanent residents to fil the position: Tro Depurontcttabourwasapoucros: No] | ves | | Ba ‘Sate brehnaning rgeristen was aprowches| No || ven Onrtetin: Eroloment gees were aproched wo | | ve Faas Media aévertament in {ame of publeaton on (dat) Full dotals ofthe outcome tothe above and oasons a 10 why suitably queliied cllzen or permanent 1s ‘dent has not been appointed: ‘Does the applicant possess any special qualitications or skills distinguishing him orher as the most sultable candidate for that position: No Yes etal, ‘Additional motivation to support the selection ofa foreign candidate: 10Details of otfer made to applicant: ‘DESCRIPTION OF OCCUPATION TO BE FOLLOWED: Nature of ane: Conwac paid ofeployat wesksmonneiesss, | ‘Sale ofored A. or ment ‘Acsonal bonets, any: ‘Summary ol tis: Prefred dat of commencement of onployment. Declaration by employer: bo 5 (first name(s) and surname) 1D Number in my capacity as - — of the above-mentioned company/organisation, hereby undertake full esponsibility for the above-named. applicant as well as his/her deportation costs should this become necessaty. | deciare that I am authorised to make this offer of employment on behalf of the alorementioned company? ‘organisation that this offer is made in good faith and will be honoured and that the above information provided by me is true and correct. | furtharmarn undartake to onsiira that the ‘applicant will comply with the Act and the Regulations made in this terms thereot and to notity the Department if the applicant is no longer employed by the mentioned company /organisation or i he (oF she is employed in another position. ‘Signe of enipioyer Signed At..nnnnnnnsne(laeg) on thie the. ay of 20, "