THENDELO YA TSHIPENTSHELA YA U FARELWA LUFHANGA NGA MUPHURESIDENNDE KHA 
MILANDU INE YA HUMBULELWA URI YO ITWA U SWIKELELA NDIVHO DZA ZWA PO.OTIKI 

MBUDZISO DZO.HE DZI FANELA U LIVHISWA KHA: 
MR N. GAWULA 
MUHASHO WA VHULAMUKANYI NA MVELEDZISO YA MULAYOTEWA 
LU.INGO: 012-357 8573 / 8626 
FEKISI: 0866 193 443 
LU.INGOTHENDELEKI: 082 466 8968 
IMPORTANT NOTE THE MAKING OF A FALSE STATEMENT IS A CRIMINAL OFFENCE 


1. 	ZWIDODOMBEDZWA ZWA VHU.E VHUKWAMANI 


1.1 	ZWIDODOMBEDZWA ZWA VHU.E: Tshifani: _____________________________________________________ Madzina nga vhu.alo (sa zwe a .waliswa zwone kha bugu ya vhune - ID): 
Nomboro ya vhu.e: ________________________________________________ 
1.2 	ZWIDODOMBEDZWA ZWA VHUKWAMANI: 
1.2.1 	.iresi ya poswo: ___________________________________________ 
.iresi ya vhudzulo: ___________________________________________ 
1.2.2 	Zwidodombedzwa zwa dzhele, arali zwi hone: Nomboro ya dzhele: ___________________________________________ .uvha .a tsinisa .ine vha nga tendelwa u wana parolo: _______________________ .uvha .a vhukuma .a u vhofhololwa: _______________________________________ Khoso dza mbueledzo/rihabi.ithesheni dzine dza dzhenelwa nga tshifhinga tsha musi vho farwa:  




2. 

ZWIDODOMBEDZWA ZWA MULANDU KANA MILANDU INE VHA KHOU HUMBELA U FARELWA LUFHANGA 

MULANDU (DZINA .A MULANDU TSUMBO U VHULAHA) (Vha .wale mulandu mu.we na mu.we u wo.he)  .UVHA .A MULANDU  FHETHU HE MULANDU WA ITWA HONE  .UVHA .A U VALELWA  KHOTHE  NOMBORO YA MULANDU  TSHIGWEVHO  


















He.i sia.ari .i fanela u .walwa thangadzina dza muhumbeli phan.a ha Muha.uli wa mulalo kana Muanisi (Arali tshikhala tsho siwaho tshi sa lingani, vha nambatedze mafhungo eneo kha sia.ari .a thungo) 

……….. Initial 





3. 	ZWIDODOMBEDZWA ZWA MULANDU KANA MILANDU NA ZWIITISI ZWA KHUMBELO 


3.1 	Kha vha .etshedze zwidodombedzwa zwi tevhelaho: 
3.1.1 	Mulandu wo itiwa hani (zwidodombedzwa zwa zwe zwa bvelela nga tshifhinga tsha u bvelela ha mulandu)): 
3.1.2 	Ndi ngani vho ita mulandu wonoyo: 




3.2 	Ho vha na muthu we a huvhala kana u lovha kana u tshinyadzwa ha ndaka nga n.hani ha zwenezwo na vhuhulwane ha mafuvhalo kana tshinyalelo.  Kha vha .etshedze na zwidodombedzwa zwa vhukwamani zwa vhapondwa, arali vha hone: 
3.3 	(a) Vho wana mbuelo vhone vha.e naa nga u ita mulandu wonoyo? 




(b) 
Arali zwo ralo, kha vha .alutshedze lushaka na vhuhulwane ha mbuelo dzenedzo. 

(c) 	
Ndivho dza po.otiki dzo vha dzi dzifhio, arali dzo vha dzi hone, dze vha vha vha tshi khou tama u dzi swikelela nga u ita mulandu/milandu yeneyo ndi dzifhio? 

(d) 	
.ihoro, dzangano, tshiimiswa, kana mbumbano kana tshigwada tsha vhalwelambofholowo tsho wana mbuelo kha u ita mulandu/milandu yeneyo naa? 






3.4  (a)  Mulandu wo itwa hu tshi tevhedzwa ndaela, thendelo ya, kana u ya nga pho.isi ya dzangano,   
nga .ihoro .a po.otiki kana dzangano, tshiimiswa, tshigwada tsha vhalwelambofholowo kana  
mbumbano na uri arali zwo ralo, kha vha bule dzina .a .ihoro .a po.otiki kana dzangano,  
tshiimiswa, tshigwada tsha vhalwelambofholowo kana mbumbano yeneyo:  
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(b)  Arali zwo ralo, vha nga .i amba zwidodombedzwa zwa ndaela yeneyo kana thendelo na .uvha  
.e ya .ewa na (ma)dzina, (dzi).iresi, nomboro dza/ya lu.ingo kana zwi.we zwidodombedzwa  
zwa muthu/vhathu vhe vha fha thendelo kana ndaela yeneyo:  
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3.5 (a) Vho vha vha muofisiri/ mufaravhuimo/ mura.o/ mutikedzi wa .ihoro .a po.otiki/ tshiimiswa/ 
mbumbano/ tshigwada tsha vhalwelambofholowo musi vha tshi ita mulandu?  Arali zwo ralo, vho zwi ita vha kha vhuimo vhufhio? 
(b) 	
Nomboro ya vhura.o, arali i hone:  ________________________________________

 (c) 	
.uvha .e vha vha mura.o wa .ihoro/tshiimiswa/mbumbani kana tshigwada tsha 
vhalwelambofholowo:  



3.6 	
Kha vha fhe zwiitisi zwa uri ndi ngani zwi tshi .o thusa lushaka arali muphuresidennde vha vha farela lufhanga. 

4. 	
ZWIDODOMBEDZWA ZWA KHUMBELO YA VHUNGOHO NA VHUPFUMEDZANI (TRC) 










4.1 	Vho ita khumbelo ya u humbela pfarelo kha TRC? 
4.2 	
Arali zwo ralo, kha vha .ee zwidodombedzwa na nomboro ndaula ya TRC:  

5. 	
.IVHAZWAKALE YA PARULA 






5.1 	Arali vha tshi khou shumela tshigwevho tshavho zwa zwino, kha vha bule arali vho no vhuya vha humbela parula: 
5.2 	Arali khumbelo yavho ya u wana parula ya haniwa, kha vha fhe tshiitisi tsha uri ndi ngani yo haniwa: 




5.3 	
Arali vho vha vho vhofhololwa nga parula, ndi dzifhio mbetshelo dze dza vha dzo vhewa kha parula yavho? (Kha vha nambatedze khophi ya maga a parula) 

6. 	
MA.WALO ANE A .O.EA 






Ma.walo a tevhelaho a fanela u nambatedzwa kha fomo ya khumbelo: 
(a) 	
Magunwe avho a vhukuma. 

(b) 	
Khophi yo khwa.hisedzwaho ya sia.ari .a u thoma .a .i.walo .a vhu.e. 

(c) 	
.humetshedzo ya A yo .adziwaho nga .ihoro .a po.otiki/tshiimiswa/mbumbano kana tshigwada tsha vhalwelambofholowo arali vha tshi tikedza khumbelo yavho. 

(d) 	
Naahu na ma.we ma.walo ane vha vha nao malugana na u ita mbueledzo/rihabiithesheni ya dzhele kana nga murahu ha u vhofhololwa dzhele. 








7. 

TSAINO NA U KHWA.HISEDZA MUANO KANA VHU.ANZI 



*(Hetshi tshipi.a tshi fanela u .adzwa na uri hu tea u .walwa thangadzina kha sia.ari .i.we na .i.we phan.a ha Muha.uli wa mulalo kana Muanisi) 
N.e ___________________________________________________________________________ Madzina na tshifani nga vhu.alo) ndi khou bula uri mafhungo a re afho n.ha ndi a vhukuma nga ngoho. 
Yo sainiwa _____________ nga .a _______ .a .wedzi wa _____________ .waha wa ______ 
Tsaino (Muhumbeli) 
1. 	
Vha a .ivha na u pfesesa zwi re ngomu ha itshi tshitatamennde? 

 Phindulo: ________________________________________ 

2. 	
Vha na zwine vha khou zwi hanedza malugana na u ita muano uyu wo randelwaho? 

 Phindulo: ________________________________________ 

3. 	
Vha dzhia uyu muano u tshi vha vhofha kha zwine vha tenda khazwo? 


 Phindulo: ________________________________________ 
A. 	Ndi khou khwa.hisedza uri ndo vhudziswa mbudziso dzi re afho n.ha na uri phindulo dzanga sa zwe zwa sumbedzwa afho n.ha dzo .walwa ndi henefho. 
  ___________________________________________________________      Tsaino ya Muani 
B. 	Ndi khou khwa.hisedza uri muani o tenda uri u a .ivha na u pfesesa zwi re ngomu ha n.ivhadzo ye ya aniwa phan.a hanga na uri tsaino ya muani yo sainiwa ndi henefho. 
  ___________________________________________________________      Muha.uli wa Mulalo Muanisi 
Dzina na tshifani nga vhu.alo 
(Nga ma.e.ere danzi) 
Vhuimo (rennge) ________________________________________________________ Ex Officio wa Riphabu.iki ya Afrika Tshipembe 



Dzina na tshifani nga vhu.alo 
(Nga ma.e.ere danzi) .uvha ________________________ Fhethu _______________________
      KANA 

1. 	Vha khou khwa.hisedza zwi re ngomu ha itshi tshitatamennde? 
 Phindulo _______________________________________ 
A. 	Ndi khou khwa.hisedza uri ndo vhudziswa mbudziso dzi re afho n.ha na uri phindulo dzanga sa zwe zwa sumbedzwa afho n.ha dzo .walwa ndi henefho. 
  ___________________________________________________________      Tsaino ya muani 
B. 	Ndi khou khwa.hisedza uri muani o tenda uri u a .ivha na u pfesesa zwi re ngomu ha n.ivhadzo ye ya aniwa phan.a hanga na uri tsaino ya muani yo sainiwa ndi henefho. 
  ___________________________________________________________      Muha.uli wa mulalo      Muanisi 
Dzina na tshifani nga vhu.alo 
(Nga ma.e.ere danzi) 
Vhuimo (rennge) ________________________________________________________ Ex Officio wa Riphabuliki ya Afrika Tshipembe 
Dzina na tshifani nga vhu.alo 
(Nga ma.e.ere danzi) 
.uvha ________________________ Fhethu _______________________ 





