SAPS 601
SOUTH AFRICAN POLICE SERVICE
APPLICATION FOR REGISTRATION AS A SECOND-HAND GOODS DEALER / RECYCLER
Section 3, 13 and 25 of the Second-Hand Goods Act, 2009 (Act no 06 of 2009)
A. FOR OFFICIAL USE BY THE POLICE STATION WHERE THE
APPLICATION IS CAPTURED
1
SAPS 603 Reference No NO YEAR
OFFICIAL DATE STAMP
(DATE RECEIVED) 2
SHG Control System Reference No
(Indicate with an X)
B. TYPE OF REGISTRATION
1 2 (Indicate period required)
Permanent Registration Temporary Registration FROM TO
C. TYPE OF CERTIFICATE (Indicate with an X)
1 2
Certificate to trade as a General Dealer/Pawnbroker Certificate to trade as an Auctioneer
3 4
Certificate to trade as a Jeweler Certificate to trade as a Motor Vehicle Dealer
5 6 (only where an application as dealer was submitted/approved)
Certificate to trade as a Scrap Metal Dealer Certificate as Recycler
D. FOR OFFICIAL USE BY THE POLICE STATION WHERE THE APPLICATION IS RECEIVED
1
Province
2
Police station
3
Component code
E. FOR OFFICIAL USE BY THE POLICE STATION
1
Outstanding/Additional information required
2 3
Persal No - Date - -
4 5
Signature of Police Officer / DSO Name of Police Officer/DSO in block letters
6
Application for Permanent Registration approved
7
Application for Temporary Registration approved FROM TO
8 9
Application for Permanent Registration refused Application for Temporary Registration refused
10
Reason(s) for refusal
11 12
Persal No - Date - -
13 14 15
Signature of Deciding Authority Deciding Officer Name of Police Officer/DSO in block letters
Code
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SAPS 601
F. PARTICULARS OF APPLICANT
NATURAL PERSON’S DETAILS
1 SA citizen Non-SA citizen*
* In case of a non-SA citizen proof of permanent residence must be submitted
3
2 Surname Initials
4 Full names
5 Identity number - - -
6 Passport number
7 Residential address
8
Postal Code
9
Name under which business is conducted
10 Business address
11
Postal Code
12
Postal address
13
Postal Code
14.1 14.2
14 Home Tel No ( ) Cellphone number
14.3 14.4
Contact details Business Tel No ( ) Fax No ( )
14.5
E-mail address
JURISTIC PERSON’S DETAILS
15 (mark with an X) Close
OTHER BODIES Company Trust Partnership Other
Corporation
If “Other” indicate the Type of Body
16
Registered name of Business
17
“Trading As” name of Business
18 (See “Other Bodies”)
Registration number
19
Postal address of Business
20
Postal Code
21
Business address
22
Postal Code
23 23.1 23.2
Tel No Fax No
Business contact
details 23.3
E-mail address
(Name and surname)
24 Responsible person
(Indicate with an X)
25 Type of citizenship applicable on responsible person SA citizen Non-SA citizen
26
Identity number of responsible person - - -
27
Passport number of responsible person
28 Cellphone number of responsible person
29 Residential address of responsible person
30
Postal Code
31 Postal address of responsible person
32
Postal Code
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SAPS 601
33
PARTICULARS OF PERSON(S) IN CONTROL OF, OR RESPONSIBLE FOR THE MANAGEMENT OF THE COMPANY, CLOSE
CORPORATION, TRUST OR PARTNERS IN CASE OF A PARTNERSHIP
34
Full names Surname Identity number Capacity
G. OTHER DETAILS
1 (Indicate with an X)
Are you a member of an accredited association? YES NO If yes, submit the following details:
2
Name of accredited association
3
Registration number of accredited association
4 4.1
Membership number Date joined - -
4.2
Expiry date - -
5
Is a copy of the applicable Government Gazette attached indicating exemptions? YES NO If no, state reasons why
6
Reasons
7
Motivate the purpose for which a certificate for Registration / Temporary Registration* to trade in second-hand goods is required
*Delete where applicable
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SAPS 601
8
Describe the goods the applicant intends to deal in (“Goods” listed in Schedule 1 of the Act)
9 (if any)
Provide the particulars of authorization(s), licence(s), certificate(s) or permit(s) held by the applicant
10
Describe the manner in which registers will be kept by the applicant
11
Describe the premises (as defined in Section 1 of the Act) where business will be conducted with reference to the location thereof as
(Attach corresponding floor plan)
well as surrounding buildings
12 (if different from Section “F” of this form)
Describe and provide the physical address of other premises where second-hand goods will be stored
13 (Only applicable on “Temporary Registration”)
Describe and provide the physical address of premises where Temporary Registration is required
14
Provide any other information which may be relevant to determine the suitability for registration as a second-hand goods dealer
15 (attach applicable documentation in support thereof)
Indicate the intended business hours during which the business will be open for trade
Week days FROM TO Hours FROM TO
Weekends FROM TO Hours FROM TO
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SAPS 601
16 (Indicate with an X)
Are you currently registered as a second-hand goods dealer/recycler in terms of the Act?
YES NO If yes, submit the following details:
Police station Registration number
Police station Registration number
Police station Registration number
Police station Registration number
Police station Registration number
17 (Indicate with an X)
Are there currently any application(s) for registration pending?
YES NO If yes, submit the following details:
Police station Reference number
Police station Reference number
18 (Indicate with an X)
Was any application in terms of the Act ever refused in the past?
YES NO If yes, submit the following details:
18.1 18.2
Business name Business address
18.3 18.4
Police station Reference number
19
Have you ever in the preceding five(5) years in the RSA or elsewhere been sentenced to imprisonment without the option of a fine in
respect of any cases of fraud, theft or corrupt activities as referred to in the Prevention and Combatting of Corrupt Activities Act,
2004 (Act No. 12 of 2004), or any contravention of the Corruption Act, 1992 (Act No. 94 of 1992), or the commission of any other
(Indicate with an X)
offence of which dishonesty is an element ?
Yes No If yes, submit the following details
19.1 19.2
Police station CAS/Case number
19.3
Charge
19.4
Outcome
19.5 19.6
Police station CAS/Case number
19.7
Charge
19.8
Outcome
20
Have you ever in the preceding ten(10) years been convicted of an offence in terms of this Act or the previous Act, irrespective of
the sentence imposed, and was within five years after the conviction again convicted of an offence in terms of any of the said Acts
(Indicate with an X)
and sentenced to a fine exceeding R1 000?
Yes No If yes, submit the following details:
20.1 20.2
Police station CAS/Case number
20.3
Offence
20.4 20.5
Police station CAS/Case number
20.6
Offence
21 (Indicate with an X)
Are you an un-rehabilitated insolvent?
Yes No If yes, submit the following details:
21.1
Date of sequestration or liquidation
21.2
Details of sequestration or liquidation
22 (Indicate with an X)
Are you by virtue of any other law disqualified from carrying on a business?
Yes No If yes, submit the following details:
22.1
Details of such law and disqualification
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SAPS 601
H. SIGNATURE OF APPLICANT, POLICE OFFICIAL AND WITNESS
1
DECLARATION BY APPLICANT
I hereby declare that I am aware that it is an offence in terms of section 32(1)( c) & (d) of the Second-Hand Goods Act, 2009 (Act No 6 of 2009),
to make a false statement in this application.
1.2
Date - -
1.3
Name and surname of applicant in block letters
1.1
PHOTO OF APPLICANT
1.4
Place
....................................................................................................
1.5
Signature of applicant
2
PARTICULARS OF POLICE OFFICIAL DEALING WITH APPLICATION
2.1
-
2.2
Name of Police Official in block letters Persal number of Police Official
2.3
2.4
Rank of Police Official in block letters Signature of Police Official
3
PARTICULARS OF WITNESS
3.1
-
3.2
Initials and Surname of witness in block letters Persal number of witness
3.3
3.4
Rank of witness in block letters Signature of witness
I. PARTICULARS OF INTERPRETER
(This section must be completed only if the applicant cannot read or write or does not understand the content of this form)
1 Name and surname of interpreter
2 Identity/Passport number of interpreter
3 Residential address of interpreter
4
Postal Code
5 Postal address of interpreter
6
Postal Code
7 7.1 7.2
Home Tel No ( ) Cellphone number ( )
Contact details of 7.3 7.4
Work Tel No ( ) Fax No ( )
interpreter
7.5
E-mail address
8 (language) (language)
Interpreted from To
9
Date - -
10 11
Place
Signature of Interpreter
12 13 -
(if applicable) 13 (if applicable)
Rank of Interpreter in block letters Persal number of Interpreter
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SAPS 601
J. FOR OFFICIAL USE BY THE DESIGNATED SECOND-HAND GOODS OFFICE
1 (Indicate with an X)
RECOMMENDATION REGARDING THE APPLICATION
1.1
New Registration recommended New Registration not recommended
1.2
Temporary Registration recommended Temporary Registration not recommended
1.3 (See Regulation 7(1), where applicable)
Reasons for recommendation
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SAPS 601
2 (if any)
Additional conditions recommended
3 4 Date - -
Name of Police Officer/ DSO in block letters
6
5
Place
Rank of Police Officer/ DSO in block letters
7 8 -
Signature of Police Officer/ DSO Persal number of Police Officer/ DSO
9
Comments by Deciding Authority (if any)
10 11 Date - -
Name of Deciding Authority in block letters
12
13
Place
Rank of Deciding Authority in block letters
14 15 -
Signature of Deciding Authority Persal number of Deciding Authority
Page 8 of 8
