I, the undersigned deponent,

Full Name:
Identity Number:

do hereby make oath and state under penalty of perjury:

1. I am an adult legal resident of the Republic of South Africa and the lawful owner / primary leaseholder of the residential property situated at:

2. I formally declare and verify under oath that the applicant,

Full Name:
Identity Number:

permanently resides with me at the above address on a full-time, continuous basis.

3. This sworn affidavit serves as valid administrative proof of residential address for the applicant in accordance with the Financial Intelligence Centre Act (FICA) of South Africa.

4. I acknowledge that I know and fully understand the contents of this declaration, that I have no objection to taking the prescribed oath, and that I consider the oath to be binding on my conscience.