Document text
Affidavit for a SAPS case — looting and damage to business premises
SOUTH AFRICAN POLICE SERVICE — [NAME OF POLICE STATION]
CAS number: [CAS NUMBER — FILLED IN BY THE POLICE] · Investigating officer: [NAME, CONTACT NUMBER — IF ALLOCATED]
Statement under oath
I, the undersigned,
[FULL NAME]
ID / passport number: [ID OR PASSPORT NUMBER]
Residential address: [ADDRESS]
Cell: [CELL NUMBER] · Email: [EMAIL]
state under oath / solemnly affirm in English as follows:
I am the [OWNER / MANAGING DIRECTOR / MEMBER / MANAGER] of [BUSINESS NAME] ([SOLE PROPRIETOR / (PTY) LTD / CC], registration number [CIPC REGISTRATION NUMBER, IF ANY]), trading at [FULL ADDRESS OF THE PREMISES, SUBURB, CITY] (the premises). I am authorised to make this statement on behalf of the business.
On [DATE] at about [TIME], during public violence in [STREET / AREA, CITY], [A GROUP OF ABOUT ___ PEOPLE / UNKNOWN PERSONS] [BROKE THE SHOP WINDOW / FORCED THE ROLLER DOOR / ENTERED THE PREMISES], [REMOVED STOCK AND EQUIPMENT / DAMAGED THE FITTINGS / SET FIRE TO ___].
[I WAS PRESENT AND SAW THE EVENTS / I WAS INFORMED BY [NAME OF EMPLOYEE OR NEIGHBOUR] AT ___ / I DISCOVERED THE DAMAGE WHEN I ARRIVED AT ___ ON [DATE]]. The premises were [LOCKED AND SECURED WITH ___] when last closed on [DATE AND TIME].
I do not know the persons involved. [OR: I CAN DESCRIBE / IDENTIFY ___.] Nobody had my permission to enter the premises or to remove or damage any property.
Property stolen or destroyed (provisional list — a full inventory will follow):
No. Item / stock Quantity Estimated value (R) Stolen or damaged
1 [E.G. CELL PHONES, CLOTHING, GROCERIES — DESCRIBE] [QTY] [AMOUNT] [STOLEN / DAMAGED]
2 [CASH REGISTER / POINT-OF-SALE TERMINAL / LAPTOP — SERIAL NUMBER IF KNOWN] [QTY] [AMOUNT] [STOLEN / DAMAGED]
3 [SHOP FITTINGS, SHELVING, FRIDGES] [QTY] [AMOUNT] [STOLEN / DAMAGED]
4 [WINDOWS, DOORS, ROLLER DOOR, SIGNAGE] — [AMOUNT] DAMAGED
5 [CASH ON THE PREMISES] — [AMOUNT] STOLEN
Total (provisional) [TOTAL]
Evidence available: [CCTV FOOTAGE FROM ___ TO ___ / PHOTOGRAPHS AND VIDEOS TAKEN ON [DATE] / STOCK RECORDS AND INVOICES]. I will make copies available to the investigating officer on request.
Witnesses: [NAME AND CONTACT NUMBER OF EACH WITNESS — OR «NONE KNOWN AT THIS STAGE»].
The premises and the business are insured with [NAME OF INSURER] under policy number [POLICY NUMBER] [, including Sasria cover]. I need the case number and a copy of this statement for my insurance claim.
I request to be informed of the progress of the investigation and of any recovered property.
I know and understand the contents of this declaration. I have no objection to taking the prescribed oath. I consider the prescribed oath to be binding on my conscience.
______________________________
[FULL NAME] (deponent)
Signed and sworn / affirmed before me at [PLACE] on [DATE] at [TIME], the deponent having acknowledged that he/she knows and understands the contents of this declaration.
______________________________
Commissioner of Oaths
Full names: [NAME] · Designation / rank: [RANK OR OFFICE] · Area: [AREA] · Business address: [ADDRESS]
BEFORE YOU GO — delete this part
Go within 48 hours. Sasria policy wordings require you to report the incident to the police and get a case number within 48 hours. Your own policy may say the same: check it.
Take with you: your ID or passport, this statement (unsigned — you sign in front of the police officer or commissioner of oaths), the list of items, photos on your phone, proof that you run the business (CIPC certificate, lease or utility bill).
Do not sign blank pages and read the statement the officer writes before you sign. Ask for the CAS number and the officer's name and phone number.
Then notify your insurer in writing — next step in the chain. Sasria cover is claimed through your own insurer or broker.
Keep the evidence: do not throw away damaged stock before the assessor has seen it, except what is dangerous; photograph everything first.
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