Dependent1

Name Age Relationship Mother Father Wife Son Other If the person is not part of your immediate family, please state why this person is dependant In which category does this person fall? Preschool Scholar Student at college/university/Technikon Adult Other Indicate the type of income received by the dependent Wages Salaries Pension Child Support Interest on investment Business profit Other Income Type Income Asset Documents/Birth Certificates

Dependent2

Name Age Relationship Mother Father Wife Son Other If the person is not part of your immediate family, please state why this person is dependant In which category does this person fall? Preschool Scholar Student at college/university/Technikon Adult Other Indicate the type of income received by the dependent Wages Salaries Pension Child Support Interest on investment Business profit Other Income Type Income Asset Documents/Birth Certificates

Dependent3

Name Age Relationship Mother Father Wife Son Other If the person is not part of your immediate family, please state why this person is dependant In which category does this person fall? Preschool Scholar Student at college/university/Technikon Adult Other Indicate the type of income received by the dependent Wages Salaries Pension Child Support Interest on investment Business profit Other Income Type Income Asset Documents/Birth Certificates

Dependent4

Name Age Relationship Mother Father Wife Son Other If the person is not part of your immediate family, please state why this person is dependant In which category does this person fall? Preschool Scholar Student at college/university/Technikon Adult Other Indicate the type of income received by the dependent Wages Salaries Pension Child Support Interest on investment Business profit Other Income Type Income Asset Documents/Birth Certificates

Dependent5

Name Age Relationship Mother Father Wife Son Other If the person is not part of your immediate family, please state why this person is dependant In which category does this person fall? Preschool Scholar Student at college/university/Technikon Adult Other Indicate the type of income received by the dependent Wages Salaries Pension Child Support Interest on investment Business profit Other Income Type Income Asset Documents/Birth Certificates