No. 2532 Government Gazette 17 May 2001 51 PART B THE FOLLOWING HAS TO BE COMPLETED BY THE ABOVEMENTIONED CANDIDATE: 1. Are you related to any recognised chief and/or head of a traditional community? Yes/No: .................................................................................. 2. If the answer is Yes, give the name or names of any such chief and/or head and the Traditional Authority which he or she leads: .................................................................................................................... .................................................................................................................... .................................................................................................................... 3. Do your culture, tradition, customs and languages differ from the abovementioned traditional authority/authorities? Yes /No ................................ 4. If answer to question 3 is Yes, state in what respect it is different: .................................................................................................................... .................................................................................................................... .................................................................................................................... I ..........................................................declare that the above information is, to the best of my knowledge and belief, correct. Signed this day..........................of .....................................at. .......................... ...................................................................... *Signature/Thumb print of candidate *Delete whichever is not applicable page 51