DECLARATION AND CONSENT BY APPLICANT

Please read this declaration carefully and provide the mandatory consent. Without consent your
application will not be processed.

I hereby apply for the social relief of distress grant (‘SRD’) in terms of the Regulations made under
Section 27(2) of the Disaster Management Act, 2002 (Act No. 57 of 2002): Measures to prevent and
combat the spread of COVID-19.

If I apply on behalf of another person (‘Applicant’), I confirm that I have the necessary authority to
provide the Personal Information of and agree to this declaration and consent, on behalf of the Applicant
and that I will inform the Applicant of the outcome of the Application.

1. I declare that:
1.1. I am / the Applicant is:
1.1.1. a South African Citizen, Permanent Resident or Refugee registered on the Home
Affairs database;
1.1.2. currently residing within the borders of the Republic of South Africa;
1.1.3. above the age of 18;
1.1.4. unemployed;
1.1.5. not receiving any form of income;
1.1.6. not receiving any social grant;
1.1.7. not receiving an unemployment insurance benefit (UIF) and do not qualify to
receive an unemployment insurance benefit;
1.1.8. not receiving a stipend from the National Student Financial Aid Scheme and other
financial aid;
1.1.9. not receiving any other government COVID-19 response support; and
1.1.10. not a resident in a government funded or subsidised institution.
1.2. All information, including Personal Information, supplied to SASSA is valid, accurate,
complete and current.
1.3. I undertake to immediately notify SASSA of any change in my / the Applicant’s contact
details or change of circumstances in relation to clause 1.1 which would disqualify me / the
Applicant from receiving a SRD grant.
1.4. I also agree to correct and update my / the Applicant’s Personal Information when
necessary.
1.5. I understand and agree that any false and/ or misleading information in the application is
punishable by law and / or that such information or any incorrect information or request to
delete my / the Applicant’s personal information, will justify a denial of or revocation of my /
the Applicant’s, application for a SRD grant by SASSA.

2. I understand that Personal Information means information relating to me / the Applicant as an

identifiable, living, natural person and includes all information supplied to SASSA in relation to my /
the Applicant’s application. I understand that when processing my / the Applicants Personal
Information, SASSA complies with the Protection of Personal Information Act, Act No. 4 of 2013
(‘POPI Act’) and all other applicable legislation. (You may find SASSA processing practices on the
SASSA website, https://www.sassa.gov.za/.)

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3. I acknowledge that any Personal Information supplied to SASSA is provided voluntarily and that
SASSA will not be able to comply with its obligations if the correct Personal Information is not
supplied.

4. I consent to –

4.1. SASSA processing, sharing, transferring and verifying my / the Applicant’s Personal
Information as provided in my / the Applicant’s application, including but not limited to,
information pertaining to my / the Applicant’s financial status, income, bank account details
with banking institutions, all government and other relevant institutions (‘Institutions’),
including fraud detection service providers deemed necessary by SASSA, to assess and
consider my / the Applicant’s entitlement to a SRD grant (‘Purpose’) (including fraud
detection) and
4.2. Institutions processing, sharing, transferring and verifying my / the Applicant’s Personal
Information, between Institutions and between Institutions and SASSA, only for the Purpose;
and
4.3. The processing, sharing, transferring and verifying of information, may take place on a
monthly basis, starting in the month of receipt of your / the Applicant’s application up to and
including October 2020 or such period that may be determined by SASSA.

5. I understand that the period for which my / the Applicant’s Personal Information would be held by
SASSA and Institutions., is for as long as is needed to achieve the Purpose or for as long as the
law requires, whichever is the longest.

6. I understand that I have a right to request access to, correction and / or deletion of my Personal
Information and the Applicant has a right to access, correct and / or delete their personal information
and that I and the Applicant may complain to the Information Regulator and withdraw consent. I
further understand that withdrawal of this consent in respect of my or the Applicant’s application will
result in the cancellation of my / the Applicant’s application for or entitlement to, the SRD grant.
Guidelines for these rights are available on the SASSA website, https://www.sassa.gov.za/.

7. I understand that privacy is important to SASSA and Institutions and that it and Institutions will use
reasonable efforts in order to ensure that any Personal Information in its possession is kept
confidential, stored in a secure manner and processed in terms of the POPI Act.

8. By submitting my / the Applicant’s personal information in any form to SASSA, I acknowledge that
such conduct constitutes a reasonable unconditional, specific and voluntary written consent to the
processing, sharing, transferring and verification of such Personal Information by SASSA and
Institutions for the Purposes including but not limited to:

8.1. The South African Revenue Services (SARS) disclosing my taxpayer information in terms
of section 69(6)(b) of the Tax Administration Act, 2011 (Act No. 28 of 2011) for the Purpose;
and
8.2. Verification of my information against the information held in the various databases such as
at the Department of Home Affairs, the Department of Labour in particular with the
Unemployed Insurance Fund and the Workman’s Compensation Fund for the Purpose.
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