Page * of *

DECLARATION AND CONSENT BY APPLICANT

Please read this declaration carefully and provide the mandatory consent to enable the processing of your application.

I hereby apply for the special COVID-19 relief grant in terms of the Directions 3 August 2021, issued in terms of the Regulations made under Section 27(2) of the Disaster Management Act, 2002 (Act No. 57 of 2002). If I apply on behalf of another person (‘Applicant’), I confirm that I have the necessary authority to provide the Personal Information of the Applicant and agree to this declaration and consent, on behalf of the Applicant and that I will inform the Applicant of all the provisions of this Declaration and Consent and of the outcome of the Application as well as the expectations should the application be successful.

1. I declare that:

1.1. I am / the Applicant is:

1.1.1. a South African Citizens, Permanent Resident or Refugee registered on the Home Affairs database or a holder of a special permit under the Special Angolan Dispensation, the Lesotho Exemption Permit dispensation or the Zimbabwe Exemption Permit Dispensation, or an asylum seeker whose section 22 permit or visa is valid or was valid on 15 March 2020; 1.1.2. currently residing within the borders of the Republic of South Africa; 1.1.3. above the age of 18 and below the age of 60; 1.1.4. unemployed;

1.1.5. not receiving any adult social grant in respect of himself or herself; 1.1.6. not receiving an unemployment insurance benefit and does not qualify to receive an unemployment insurance benefit;

1.1.7. not receiving a stipend from the National Student Financial Aid Scheme or other financial aid; 1.1.8. not receiving any other government COVID-19 response support; and 1.1.9. 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 financial circumstances, contact details or change in circumstances in relation to clause 1.1 which would disqualify me / the Applicant from receiving the COVID-19 special relief of distress grant. 1.4. I also agree to correct and update my / the Applicant’s Personal Information if it has changed. 1.5. I confirm that the mobile phone number provided is the number at which the Applicant can be contacted and that this is the acceptable channel for all communication from SASSA for the purposes of this grant. If this number changes, I undertake to immediately update the number with SASSA. 1.6. 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 the special relief of distress grant by SASSA.

2. I understand that Personal Information has the meaning ascribed to it in terms of the Protection of Personal Information Act, Act No. 4 of 2013 (‘POPI Act’) and 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 will comply with the POPI Act and all other applicable legislation.

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 or reserves its right not to comply with its obligations, if incorrect Personal Information is supplied.

4. I confirm that I am aware of the “How my grant works” advisory document (also published on the SRD website) that outlines how I can apply, as well as aspects like my right to reconsideration which I must do on a monthly basis if declined. I agree that I know that I can contact the SASSA Call Centre for assistance with application or to understand my rights and responsibilities in any language of my choice. Page 2 of 2

5. I consent to –

5.1. 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, other government and other relevant institutions (‘Institutions’), including fraud detection service providers deemed necessary by SASSA, to assess and consider my / the Applicant’s application for a social grant (‘Purpose’) and 5.2. Institutions processing, sharing, transferring and verifying my / the Applicant’s Personal Information, between Institutions and SASSA, only for the ‘Purpose’;

6. 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 it is needed to achieve the Purpose or for as long as the law requires, whichever is the longest.

7. 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 the special relief of distress grant. Guidelines for these rights are available on the SASSA website, https://www.sassa.gov.za/. 8. 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.

9. 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: 9.1. 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; 9.2. 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.

9.3. Commercial banks registered in South Africa to confirm my financial status. 9.4. SASSA may verify my / the Applicant’s information against commercial risk management institutions such as TransUnion and South African Fraud Prevention Service for the purposes of ensuring that I / the Applicant am/is not a perpetrator of fraud.

9.5. I understand that SASSA may decline my / the Applicant’s grant based on findings made by the Auditor General of South Africa (AGSA) based on databases which they may have at their disposal. I also agree that SASSA may request my/ the Applicant’s information which is in the possession of the AGSA from them for the purposes of verifying my / the Applicant’s income.

9.6. SASSA may share information with other government institutions such as the AGSA for auditing and planning purposes.

9.7. SASSA may also share my / the Applicant’s Personal Information where its processing involves a clear benefit to the applicant/data subject such as referral to economic and development opportunities.