FORM TO BE COMPLETED REGARDING AN INTENDED CLAIM FOR ALLEGED DAMAGES, BROUGHT AGAINST THE DEPARTMENT OF ROADS & TRANSPORT

Attention is drawn to the following aspects:

• It is essential that all the required particulars and information referred to in this form, be supplied by the claimant in order to enable the Department to consider the claim as expeditiously as possible

NB: Any request to complete this form is solely to obtain full particulars from the claimant in order to evaluate the claim and must in no way be construed as acceptance of liability by the Department

• The complete form and required documents must be forwarded or hand delivered to:

Department of Roads & Transport

1215 Nico Smith Street

Koedoespoort

PRETORIA

Tel. No.: 012 310 2200