Declaration - ActionSA

CANDIDATES DECLARATION

First Name

Last Name

Phone Number

Email Address

ID Number

Province

I, the undersigned, do hereby declare that the information contained herein fall within my personal knowledge and are to the best of my knowledge complete, true and correct.

True False

I am South African citizen or permanent resident

True False

I am a member of ActionSA and do not hold membership of any other political party

True False

I shall be at least 18 years by the date of the National and Provincial Elections

True False

I am not in arrears with my rates and tariffs owing to the municipality

True False

I am, to the best of my knowledge, not under investigation for any criminal offence

True False

I have not been convicted of a criminal offence and sentenced to more than 12 months imprisonment without the option of a fine either in the Republic, or outside of the Republic if the conduct constituting the offence would have been an offence in the Republic and a period of 5 years has not elapsed since the sentence was completed.

True False

I am not aware of anything about my either personally or professionally about myself that could foreseeably bring the name of ActionSA into disrepute.

True False

I have not been declared as an unrehabilitated insolvent.

True False

I have not been deemed to be of unsound mind by a court of the Republic.

True False

I am not in the employ of a company, organisation or tier of government that would prohibit my employment as a Member of Parliament and Member of Provincial Legislature.

True False

I will subject myself to the performance management process as prescribed by the Senate of ActionSA.

True False

I have read and understood the candidate’s responsibility towards payment of candidate fees and Public Representative contribution.

True False

If elected, I will declare my financial interests, non-executive directorship previously or currently held and remunerative work, consultancy and retainership positions.

True False

The deponent having acknowledged that he knows and understands the contents of this affidavit, that the contents are true, and that he has no objection to taking this oath and that he considers the oath to be binding on his/her conscience.