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Form D4
Application or request to the Registrar
(Regulation 24)
(Lodge in duplicate)
Application No.:
Date of lodgement:
Full names) of applicant(s):
In terms of the following sections and regulations:
(a)
section
(b)
regulation
the applicant hereby requests the following:
Documents, if any, lodged in support of the request:
Date:
_________________________________
APPLICANT/APPLICANT'S AGENT
Address for service:
FOR OFFICIAL USE ONLY
Official date stamp
……………………
The above application or request is hereby allowed / refused Reasons for refusal or
conditions of allowance, if any: