500m RADIUS AFFIDAVIT
Date: (Date of Affidavit.)
I, the undersigned
(Name of Applicant or Entity / Business – Reg Nr of Applicant or Entity)
t/a (Name of Store / Business Trading Name)
Do hereby make oath and state as follows:
- My name is (Name of Applicant or Business Name), Identity number / Company Registration Number: ____obo (Name of Applicant or Business Name – Reg Nr of Business or ID of Applicant. I am an adult male / female using (Full Address of Applicant), Mobile: _______________ –
eMail: (email of applicant) as my residential address, mobile and correspondence email address.
- I am employed and / self-employed.
- I state that it is according to my knowledge and observation that I have not seen any school, church and similar liquor licensed outlet within a radius of 500 metres from the address: (Full address of premises / shop, including ERF Number.)
I CERTIFY THAT THE DEPONENT ACKNOWLEDGED TO ME THAT HE KNOWS AND UNDERSTAND THE CONTENT OF THIS DECLARATION. THAT HE HAS NO OBJECTION TO TAKING THIS DECLARATION. THAT HE HAS NO OBJECTION TO TAKING THIS OATH AND CONSIDERS IT BINDING ON HIS CONSCIENCE.
THUS SIGNED AND SWORN BEFORE ME: (MEMBER OF SAPS.)
Me / Mr. _____________________(Applicant) obo (Business Name) – Reg Nr: (Business Reg Nr.)
COMMISSIONER OF OATHS: