Annex 23B: APPLICATION FOR A POLICE CLEARANCE CERTIFICATE SURNAME *MAIDEN NAME GIVEN NAMES DATE OF BIRTH (YR/MTH/DAY) PLACE OF BIRTH SOUTH AFRICAN ID NO LAST RESIDENTIAL ADDRESS IN RSA CODE TEL OF ABOVE (CODE + NO) LAST BUSINESS/ EMPLOYER’S ADDRESS IN RSA CODE TEL OF ABOVE (CODE + NO) MAILING ADDRESS IN COUNTRY OF APPLICATION CODE TEL OF ABOVE (CODE + NO) E-MAIL ADDRESS *If Applicable SIGNATURE: DATE: Note: This form is not a prescribed form from SAPS. It has been developed by the Department of Foreign Affairs to assist applicants. Attach full set of fingerprints, copy of ID document/passport, ZAR59-00 banker’s draft, money order or proof of electronic payment to the National Commissioner of the South African Police Service. Send to: Criminal Record Centre, 1st Floor, Room 14, Botongo Plaza West, 271 Schoeman Street, Pretoria, 0001, Republic of South Africa. If authentication by Department of Foreign Affairs is needed, include: Cover letter to SAPS - Criminal Record Centre explaining arrangements made; and Cover letter to the Department of Foreign Affairs - Legalisation Section indicating country in which certificate will be used.