FORM 46: Application of a Third Party to Register a Person as an Excluded Person

1 Step 1

1. I (Name of Applicant):

do hereby, in terms of the provisions of the Act and these Regulations, apply for the exclusion of

(Names of person to be excluded)

2. Physical address of applicant

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Postal address

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Telephone

Fax

Tax No.

3. State the reason(s) for the application:

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4. State the relationship of the Applicant to the person to be excluded:

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DOCUMENTS TO BE SUBMITTED WITH THIS APPLICATION

1. Two identical and recent coloured passport-size photos of the person to be excluded;

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2. Certified copy of identity document (Omang or passport) of the person to be excluded and the Applicant.

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I certify that the information supplied on this application form (please print name clearly) is true and correct. I understand that failure to provide true and correct information will result in the failure of this application.