J101 E Form PDF Details

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QuestionAnswer
Form NameJ101 E Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesj101 e form, maintenance application form, application for maintenance order form, application maintenance form online

Form Preview Example

J101 E

REPUBLIC OF SOUTH AFRICA

APPLICATION FOR MAINTENANCE ORDER

COMPLAINT IN TERMS OF SECTION 6(1) (a) OF THE MAINTENANCE ACT, 1998 (ACT No. 99 OF 1998)

* Delete whichever is not applicable.

Reference No

 

 

[This information should, as far as possible, be given in order to investigate the complaint. If space is insufficient information should be supplied on an attached annexure.]

I, (full name)

 

 

 

 

 

 

 

 

 

 

 

 

 

, (called "the complainant")

born on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d

 

d

m

m

y

y

age

 

ID number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

living at

 

 

 

 

 

 

 

 

 

working at

………………

………………

………………

………………

………………

………………

………………

………………

tel. no (…….…)

................................................................

 

 

 

 

 

 

tel. no (…….…)

nearest police station

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

hereby *declare under oath/truly affirm as follows:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. (Full name)

 

 

 

 

 

 

 

 

 

 

 

 

 

, (called "the defendant ")

 

 

 

 

 

 

 

 

 

born on

d

 

d

m

m

y

y

age

 

ID number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

living at

 

 

 

 

 

 

 

 

 

working at

………………

………………

………………

………………

………………

………………

………………

………………

tel. no (…….…)

................................................................

 

 

 

 

 

 

tel. no (…….…)

nearest police station.........................................................................................................................................................................

is legally liable to maintain *me and/or the following child(ren) mentioned in 4. below, who is/are under my care.

J101 E

2.*The defendant is legally liable to maintain me because: ………………………........................................................................

………...............................................................................................................................................................................................

………...............................................................................................................................................................................................

*The child(ren) mentioned in 4. below is/are under my care because ………………………………………………………….….

………...............................................................................................................................................................................................

………...............................................................................................................................................................................................

3. The defendant has not supported *myself/the said child(ren) since (date)

and has

made *no contribution towards maintenance/the following contribution towards maintenance:

 

………...............................................................................................................................................................................................

………...............................................................................................................................................................................................

4.I request that the Defendant be ordered to make the following contribution(s) towards maintenance: A *weekly/monthly contribution of –

R............................ in respect of myself (complainant), and / or

 

Amount

Name of Child

 

 

 

Born

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

in respect of

 

d

d

m

m

y

y

y

y

 

 

 

 

 

 

 

 

 

 

 

 

R

 

in respect of

 

d

d

m

m

y

y

y

y

 

 

 

 

 

 

 

 

 

 

 

 

R

 

in respect of

 

d

d

m

m

y

y

y

y

 

 

 

 

 

 

 

 

 

 

 

 

R

 

in respect of

 

d

d

m

m

y

y

y

y

 

 

 

 

 

 

 

 

 

 

 

 

R

 

in respect of

 

d

d

m

m

y

y

y

y

 

 

 

 

 

 

 

 

 

 

 

 

R

 

in respect of

 

d

d

m

m

y

y

y

y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d

d

m

m

y

y

y

y

The first payment should be made on ................................................ and after that on or before the ......................... day of each

succeeding *week/month. All payments should be made to ……...................................................................................................in

favour of

...........................................................................................................................................................................................;

 

and/or

other contributions [for example medical and dental costs, school fees, fees to tertiary institutions, school wear, expenses for

sport and/or cultural activities, birth expenses and maintenance for child(ren) from birth]: …..........................................................

...........................................................................................................................................................................................................

...........................................................................................................................................................................................................

...........................................................................................................................................................................................................

5.Particulars of my assets and *monthly/weekly income and expenditures (supported by documentary proof, where possible) are as follows:

2

J101 E

 

 

 

 

ASSETS

 

 

 

INCOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fixed property

 

R

Gross salary

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Investments

 

R

Minus: Deductions

Tax

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical Aid

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Savings

 

R

 

 

Pension

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other:

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Shares

 

R

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Motor vehicles

 

R

Total nett salary

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other:

 

 

R

Other income

 

 

R

 

 

 

 

 

 

(state source of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

income)

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total income

 

 

R

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Expenditure

 

Self

 

Child(ren)

 

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1Lodging (bond repayment/levy /rent/ board)

2Groceries/food/personal care (including hair care/cosmetics etc.)

3

Household

Water and electricity / gas /

 

expenditure

paraffin

 

 

 

 

 

 

 

Rates and taxes

 

 

 

 

 

 

Laundry/Dry-cleaning

 

 

 

 

 

 

 

Lunches

 

 

 

 

 

 

 

Telephone

 

 

 

 

 

 

Domestic worker

 

 

 

 

 

 

Garden services

 

 

 

 

 

 

Insurance (short term)

 

 

 

 

4

Clothing

Clothes and shoes

 

 

 

 

 

 

School uniforms

 

 

 

 

 

 

Sports clothes

 

 

 

 

5

Transport

Bus / taxi / lift club

 

 

 

 

 

 

 

Car

 

Installments &

 

 

 

 

Insurance

 

 

 

 

Maintenance

 

 

 

 

 

 

 

 

 

Fuel

 

 

 

 

 

 

 

 

 

Licences

 

 

 

 

 

 

 

 

 

Parking

 

 

 

 

 

3

J101 E

 

Expenditure

Self

Child(ren)

Total

 

 

 

 

 

 

6

Educational

School fees

 

 

 

 

expenditure

 

 

 

 

 

 

Crèche / day care / after school

 

 

 

 

 

care

 

 

 

 

 

Insurance (study policy)

 

 

 

 

 

 

 

 

 

 

 

Books / Stationery

 

 

 

 

 

 

 

 

 

 

 

Outings / Extramural

 

 

 

 

 

 

 

 

 

 

 

Sports

 

 

 

 

 

 

 

 

 

 

 

Other school expenditure

 

 

 

 

 

 

 

 

 

7

Medical expenditure

Doctor/dentist/etc.

 

 

 

 

 

 

 

 

 

 

 

Medication

 

 

 

 

 

 

 

 

 

 

 

Hospital

 

 

 

 

 

 

 

 

 

 

 

Other medical expenditure

 

 

 

 

 

 

 

 

 

8

Insurance

Life

 

 

 

 

 

 

 

 

 

 

 

Annuity

 

 

 

 

 

 

 

 

 

 

 

House owners/House holders

 

 

 

 

 

 

 

 

 

9

Pocket money/ Allowances

 

 

 

 

 

 

 

 

10

Holidays, entertainment & recreation (incl M-Net)

 

 

 

 

 

 

 

 

 

11

Maintenance,

House

 

 

 

 

replacement and

 

 

 

 

 

Household appliances

 

 

 

 

repairs of items

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Kitchenware

 

 

 

 

 

 

 

 

 

 

 

Linen, towels, etc.

 

 

 

 

 

 

 

 

 

 

 

*Bicycles/bikes/scooters

 

 

 

 

 

 

 

 

 

 

 

Other items

 

 

 

 

 

 

 

 

 

12

Personal loans

 

 

 

 

 

 

 

 

 

 

13

Security alarm system

 

 

 

 

 

 

 

 

 

 

14

Membership fees

 

 

 

 

 

 

 

 

 

15

Religious contributions/ Charities

 

 

 

 

 

 

 

 

 

16

Gifts

 

 

 

 

 

 

 

 

 

 

17

TV licence

 

 

 

 

 

 

 

 

 

 

18

Reading material

Books / Newspapers /

 

 

 

 

 

Periodicals

 

 

 

19

Lease / credit

Furniture

 

 

 

 

agreement payments

 

 

 

 

 

Appliances

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

20

Pets

Food

 

 

 

 

 

 

 

 

 

 

 

Veterinary surgeon ("vet")

 

 

 

 

 

 

 

 

 

 

 

Licence

 

 

 

 

 

 

 

 

 

4

J101 E

Expenditure

Self

Child(ren)

Total

 

 

 

 

21Other (not specified above)

Total expenditure

Dated at

this

day of

year

............................................................

Signature of Complainant

5

J101 E

* Delete whichever is not applicable

FOR OFFICIAL USE ONLY

Oath/Affirmation

1.I certify that before administering the *oath/affirmation I asked the complainant the following questions and wrote down *his/her answers in *his/her presence:

(a) Do you know and understand the contents of the declaration?

Answer

(b) Do you have any objection to taking the prescribed oath?

Answer

(c) Do you consider the prescribed oath binding on your conscience?

Answer

2.I certify that the complainant acknowledged that *he/she knows and understands the contents of this declaration. The complainant uttered the following words *"I swear that the contents of this declaration are true, so help me God"/"I truly affirm that the contents of the declaration are true". The *signature/mark of the complainant was affixed to the declaration in my presence.

............................................................................

Justice of the Peace/Commissioner of Oaths

Full name and surname (block letters) ……………………………………………………………………………..................................

Designation (rank)

................................................................................................................. Ex Officio Republic of South Africa

Business address

(street address must be stated

.......................................................................................................................................................................................................

Dated at

this

day of

year

6

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1. The j101 needs specific information to be inserted. Be sure the next fields are finalized:

Filling in segment 1 in j101 form

2. Given that the previous segment is completed, it's time to put in the needed particulars in hereby declare under oathtruly, Full name called the defendant, born on, d m m, age, ID number, living at, working at, tel no, tel no, nearest police station, and is legally liable to maintain me in order to proceed to the third part.

How to complete j101 form step 2

3. Completing J E, The defendant is legally liable to, The children mentioned in below, The defendant has not supported, made no contribution towards, I request that the Defendant be, R in respect of myself complainant, Amount, Name of Child, and Born is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Tips to complete j101 form portion 3

You can potentially make errors when completing your The children mentioned in below, consequently be sure you reread it before you'll finalize the form.

4. To go forward, the following step involves typing in a few blanks. These comprise of Amount, Name of Child, Born, in respect of, in respect of, in respect of, in respect of, in respect of, in respect of, d m m, d m m, d m m, d m m, d m m, and d m m, which you'll find fundamental to going forward with this process.

Part number 4 in completing j101 form

5. While you approach the last sections of the file, you will find a couple extra requirements that need to be fulfilled. In particular, sport andor cultural activities, Particulars of my assets and, and are as follows should be filled out.

Step # 5 for submitting j101 form

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