sample BI-9 - South Africa

FOR OFFICIAL USE ONLY.PR FUNCTIONS.$vpREPUBLIC OF SOUTH AFRICA BI-9l/ ,\L?JiDEPARTMENT OF HOPvlE AFFAIRSF' ST APPbBCATKlM FOR AM $DENKlTY CARDTHIS FORM MUST BE DULY COMPLETEDDemographics not on PR = Function 36 (006)TWO RECENT PHOTOS TO BE SUBMITEDHANlS FUNCTION / SUB-FUNCTIONCard to be producedEl0 0 - 0 0 0Demographics on PR = Function 37 (01 1) No card to be produced 0 0 - 0 1 0Replacement = Function 38 (010) Change of registered fingersldate of birth 0 0 - 0 2 0Demographics on PR (Reference Books) = Function 39 (1 60)Identity number 1 6 1 7/ 0 1 1 I 01 4 1 1-Maiden nameo Date of birthIf S.A. citizen by naturalizatiol0 CERTIFICATE NUMBER o DATE OF ISSUEcquired South AfricanCITIZENSHIPDid you acquire the citizenship of any other country? 1-10If Yes, when? 1-1Of which country? I I I I I I I I 1 I I I I I ]How?By birthBy naturalizationBy descentOtherPost receivingSpecify ..........................................................................................................................................................In which country was the application made? ..............................................................................................ADDRESS0 Permanent residential address 0 Postal addressOFrZICE STAMP[ 0 Province code m,Maiden nameGENERAL Reference Book-/ID Card numberTBVC-Identity numberDate of applicationcLIruInapplicantRemarks......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Signature of official checking the formIdentity No. m l

FIRST APPLICATION FOR ANIDENTITY CARDKgPKFingerprints may only be taken by an official of the1 Department of Home Affairs. PLEASE NOTE: Should afinger be missing, deformed or so injured that the- 83 impression cannot be taken, this fact should be noted Iin the space provided for that impression.FmFINGERPRINTS TAKEN BY:(PLEASE PRINT)IDENTITY NUMBER:r9 CECIL SYLVIA M. JOTvES' APPLICANT(a) IDENTITY NUMBER:5 k0 I6I7IoI10 b b It Q d d 81611kis2KXWnzPKRIGHT THUMB