Protective Registration

SAFPS --> Protective Registration

TrueFalse Are you a victim of impersonation?

Protective Registration It is of utmost importance that you enter your information and details as accurately as possible, so as to ensure
that we can assist you if you become a victim of Identification fraud.Your Personal Details -If Yes; Please advise the name/s of the organisations were you have been impersonated together with any reference numbers or contact detailsTel Police - (Country Code, Area Code, Number)Case/Incident Report NoSAPS Station AddressDate of ReportPolice Involvement Date Lost/StolenDocument Lost or Stolen Your reason for seeking Protective Registration EmployerTel Cell / Mobile - (Country Code, Area Code, Number)Tel Work - (Country Code, Area Code, Number)Tel Home - (Country Code, Area code, Number)Country of ResidencePostal CodeResidential Address PassportID NumberE-mail Address Birth DateForename(s)SurnameTitle LostStolenOther

Note: Protective registration is a benefit to you but for which SAFPS and its Members accept no liability or
responsibility. By applying for protective registration you accept that this exclusion is reasonable. You must take
all other necessary precautions to protect yourself. It is in your interest to provide the fullest information on this form.
If the form is not properly completed, Protective Registration cannot be processed.

Your Declaration

I request Protective Registration by South African Fraud Prevention Service(SAFPS) and declare that the information
provided in this application is true and correct. I understand that I must first make a report to the Police with regard to the
loss and/or theft of my identity document and obtain an appropriate reference.
I understand that it is a criminal offence to make a false report to the Police and that SAFPS will institute criminal charges
against me should I make a false affidavit or statement thereby avoiding my legal responsibilities in regard to any matter for which I have a liability.
I agree to the information provided being made available to SAFPS members and other bona fide agencies for the purposes of fraud prevention.
I indemnify SAFPS, its Members, Agents and Servants against any liability, loss, claim or proceedings whatsoever, whether arising in common law or statute, however arising out of in the course of or caused by the carrying out of any service by
SAFPS, whether due to any act or omission of SAFPS or their Members, Agents and Servants or otherwise.

I Accept

All loss or theft must be reported to the Police before it can be entered onto the SAFPS database

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