Indemnity

Yzerfontein Neighbourhood Watch  Indemnity form

 

 INDEMNITY

 

I, _______________________________________________________

(Full Names)

with Identity Number   __________________________________________

residing at ________________________________________________________

(Residential Address)

Cell Phone: ________________________________________________________

Landline: ________________________________________________________

Email: ________________________________________________________

Do hereby

1) Acknowledge that I have read the Code of Conduct as extracted from the Constitution of the Yzerfontein Neighbourhood Watch and fully understand the terms thereof;

2) Acknowledge that I have chosen to be a member of Yzerfontein Neighbourhood Watch and voluntarily participate in Neighbourhood Watch activities;

3) Acknowledge further, that the Yzerfontein Neighbourhood Watch is not a corporate entity established by or under any law nor does it have juristic personality;

4) Indemnify the aforesaid Yzerfontein Neighbourhood Watch , its committee and other members, in respect of any criminal or civil liability, against any costs, claims, suits or damages howsoever arising directly or indirectly from any intentional act or omission or any negligence on my part.

5) Volunteer the answer to the following question: “Have you ever been convicted of any criminal offence? If so, date and sentence”.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6) Declare that there are no other relevant matters that I believe should be brought to the attention of the Committee of the Yzerfontein Neighbourhood Watch to enable this application for membership to be properly considered.

I hereby authorise the Yzerfontein Neighbourhood Watch Management to make my details available to the Darling South African Police Services, for the purposes of a criminal activity check and authorize SAPS Darling to furnish personal information regarding my criminal background, criminal history, previous convictions and / or any other relevant information such as usually furnished by the Criminal Record Centre of the South African Police Service in this regard, to the Committee of the Yzerfontein Neighbourhood Watch for consideration with this application.

I warrant that the information in this application is true and correct and will be relied upon by the Yzerfontein Neighbourhood Watch in consideration of this application.

I understand that any false statements or misrepresentation will entitle the Committee of the Yzerfontein Neighbourhood Watch to disregard this application, or alternatively, if my membership has already been approved in ignorance thereof, the membership will be revoked summarily.

I also agree to inform the Yzerfontein Neighbourhood Watch Committee of any criminal charges and convictions brought against me whilst I am a member of the said Neighbourhood Watch.

Signed At ____________________________________ On This  ______  Day Of _________________________________  20_________

Member Signature:_____________________________________

Witness: ___________________________________________

____________________________________________________________________
SAPS SC: ___________________ SAPS CLEARANCE: ___________________

DATE: _________________________   DATE: __________________________
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