Act 125 of 1995 on the National Security Services - Legislationline

Annex 3 to <strong>Act</strong> <strong>125</strong> <strong>of</strong> <strong>1995</strong>
Strictly confidential
Particularly important
(after completion)
SECURITY QUESTIONNAIRE
for the security check <strong>of</strong> candidates for or holders <strong>of</strong> important and confidential jobs
Type "A" check
General details
1. Family name and first name:
2. Previous names (maiden name):
3. Day, month, year, and place <strong>of</strong> birth:
4. Mother’s name:
5. ID document number:
Citizenship details
6. Current citizenship:
7. Previous citizenship (country, time, number <strong>of</strong> relevant document):
8. Foreigners and holders <strong>of</strong> dual citizenship:
First day <strong>of</strong> stay in this country:
Legal title, status:
Number and date, and issuing authority <strong>of</strong> residence permit:
Passport number:
Name <strong>of</strong> authority that handles application for permanent residence, and immigration:
Date <strong>of</strong> submitting application for naturalisation and citizenship, name <strong>of</strong> competent authority processing the case:
Marital status, family relatives
9. Marital status:
Married, bachelor, single, divorced, living in life partnership, widow/widower
10. Information concerning current spouse, partner
Family name and first name:
Previous names (maiden names):
Day, month, year, and place <strong>of</strong> birth:
11. Personal details <strong>of</strong> children:
Family name and first name:
Day, month, year, and place <strong>of</strong> birth:
Mother’s name:
Family name and first name:
Day, month, year, and place <strong>of</strong> birth:
Mother’s name:
Address, place <strong>of</strong> residence
12. Present permanent address (locality, district, street, number, building, floor, door number):
13. Temporary address:
14. Residence, where you are accessible, address, phone number (if not identical to the permanent, or temporary
address):
Schooling
15. Highest school qualification, number and date <strong>of</strong> certification document:
16. Name <strong>of</strong> the issuing institution <strong>of</strong> education: