G.P.-S.

003-0318 J243

REPUBLIC OF SOUTH AFRICA

INVENTORY
In terms of section *9 (1) (a)/9 (2) (a)/9 (2) (b)/27/78 of the Administration of Estates Act, 1965.

Attention is directed to the provisions of section 102 (1) (b) of the Act which provides that any person who wiífully makes any false inventory under the Act shal!
be guilty of an offence and liable on conviction to a fine not exceeding R1 000 or to imprisonment for a period not exceeding five years or to both such fine and
such imprisonment.

* Full name of deceased …...........................................................................................................................................................................

Full name of surviving spouse (in a case where spouses were married in community of property)

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

Address of surviving spouse

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

Massed estate of …......................................................................................................................................................................................

of/or

* Full name(s) of minor(s) under tutorship or person in respect of whose property letters of curatorship have been granted:

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

Full address ….............................................................................................................................................................................................

l(full name) ...................................................................................................................................................................................................

of (full address) …........................................................................................................................................................................................

in my capacity as..........................................................................................................................................................................................

hereby declare that to the best of my knowledge and belief the with-in mentioned is a true and correct inventory—

* (a) of all property known to me to have belonged, at the time of death, to the *above-named deceased/joint estate of the above-
named deceased and surviving spouse/above-named massed estate;

* (b) of all property known to me to have been in the possession of the above-named deceased upon the premises at

………………………………………………………..............................................................................................at the time of *his/her death;

* (c) showing the value of all property in the above-named estate;

* (d) of all the property taken care of or administered by me.

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

Place Date Signature

…...……………………………..
Print Name and Surname
Names and addresses of persons having an interest in the estate as heirs in whose presence this inventory was made. (To be
furnished in the case of an inventory under section 9 of the Act):

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

* Delete which is not applicable

DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT

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1. Immovable property

Description of property according to the title deed (also state number and date Value
thereof) R c

Total …….. R 0.00

DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT

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2. Movable property
Description Value
R c

Total …….. R 0.00

DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT 3

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3. Claims in favour of estate
Description Value
R c

Total …….. R 0

R c
SUMMARY
0
1. Immovable property ………………………………………………………………………. ……………… …………
0
2. Movable property ………………………………………………..………………………… ……………… …………

3. Claims in favour of estate ………………………………………………………..…….... 0……………… …………

Total ……… R 0

DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT 4