Addendum - South Africa

B. PARTICULARS OF PERSON(S) FOR WHOM ADMISSION TO SOUTHAFRICA IS SOUGHT1. Surname Christian Age Relationship Occupation (ifNames to sponsor to be followed in SA)________________________________________________________________________________a ) _____________________________________________________________________________b) _____________________________________________________________________________c) _____________________________________________________________________________d) _____________________________________________________________________________2. Particulars of financial means i.e. fixed assets, transferable pension, other income, etc:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3. Address(es) of person(s) mentioned under B.1________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4. Particulars of other children irrespective of whether or not they will accompany the sponsoredperson(s) to South Africa:a ) _____________________________________________________________________________b ) _____________________________________________________________________________c ) _____________________________________________________________________________5. Did the person (s) sponsored previously reside in South Africa? If so, for how long?________________________________________________________________________________

C. UNDERTAKING BY SPONSORI, ____________________________________________________________________________The undersigned, hereby declare that the information furnished under Section A and B of thisform is correct and I undertake to provide the person(s) mentioned under paragraph B.1 with thenecessary board and lodging and to maintain him/her/them at all times while resident in SouthAfrica so that he/she/they will not become a burden on the State and I further undertake thatshould I fail to provide the person(s) as foresaid, to pay to the South African Government anycosts or expenses incurred or to be incurred by it in providing such board and lodging andmaintenance.I further undertake that, should it become necessary to deport or repatriate the said person(s)from the Republic, I will pay to the South African Government any costs or expenses incurred orto be incurred by it for or arising out of such deportation or repatriation.Dated at: _____________________________________ on the ________________________of __________________________________Signature: ____________________________________Address: ________________________________________________________________________________________________________________AS WITNESSES:1. Signature: ___________________________________________________________Address: _________________________________________________________________________________________________________________________________2. Signature: ____________________________________________________________Address: __________________________________________________________________________________________________________________________________