UKUKHULULWA OKUKHETHEKILEYO NGOKUXOLELWA NGUMONGAMELE NGOKUPHATHELENE NE(AMA)TYALA EKUSOLWA UKUBA ENZIWE UKUZE KUPHUNYEZWEIINJONGO ZEZOPOLITIKO 
YONKE IMIBUZO YMAYIBHEKISWE KU: MNU N. GAWULA ISEBE LEZOBULUNGISA NOPHUHLISO LOMGAQO-SISEKO INOMBOLO YOMNXEBA: 012-357 8573 / 8626 IFEKSI: 0866 193 443 ISELULA: 082 466 8968 

1.1 	IINKCUKACHA ZOBUQU: IFani: _____________________________________________________ Amagama apheleleyo (njengoko evela kwincwadi yakho YESAZISI (ID)): 
Inombolo yesazisi: ________________________________________________ 
1.2 	IINKCUKACHA ZOQHAGAMSHELWANO: 
1.2.1 	Idilesi yeposi: ___________________________________________ 
 Idilesi yesitalato: ___________________________________________ 

1.2.2 	Iinkcukacha zentolongo, ukuba zikhona:  Inombolo yasentolongweni: ___________________________________________ Owona mhla ukufutshane onokulungela ngawo ingqawule: _______________________ Umhla ekufaneleke ukuba ukhululwe ngawo:  _______________________________________ Izifundo zokukubuyisela kwisimo sangaphambili ozenzileyo ngexesha lokuvalelwa entolongweni: 
Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 

2. IINKCUKACHA ZE (AMA) TYALA UXOLELO OLUFUNELWA ZONA


ITYALA (UHLOBO LWETYALA UMZEKELO. UKUBULALA)(Dwelisa ityala ngalinye ngokwahlukeneyo)  UMHLA WOKWENZIWA KWETYALA  INDAWO ELENZIWE KUYO ITYALA  UMHLA WOKUGWETYW A  INKUNDLA  INOMBOLO YETYALA  ISIGWEBO  




















Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala 
……….. Faka oonobu mba bamaga ma 
3. 	IINKCUKACHA ZE(AMA)TYALA KUNYE NOKUPHEMBELELA ISICELO 
3.1 	Nika ezi nkcukacha zilandelayo: 
3.1.1 	Ingaba lenziwa njani i(ama)tyala (iinkcukacha zokwenzekayo ngexa lokwenziwa 
kwe(ama)tyala: 

3.1.2 	Kwakutheni ukuze lenziwe i(ama)tyala: 
Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 
……….. 


3.2 	Ingaba kwabakho umntu owenzakalayo okanye obulawayo okanye ingaba ukhona umntu owehlelwa ngumonakalo kwipropati ngenxa ye(yama)tyala elinjalo kunye nobungakanani bako nakuphi na ukwenzakala kunye/okanye umonakalo kwakhona nceda unike iinkcukacha zoqhagamshelwano zamaxhoba, ukuba ziyafumaneka: 
3.1.3 	(a) Ingaba waye wazuza wena buqu ngayo nangayiphi na indlela ngokwenza elo/loo (ma)  tyala? 
Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 
……….. 

(b) Ukuba kunjalo, cacisa ubunjani kunye nobungakanani beenzuzo ezinjalo. 
Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 
……….. Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 


3.4  (a)  Ingaba i(ama)tyala lenziwa kuqhutywa umyalelo, ukuvunywa, okanye ugunyaziso   
ngokwemigqaliselo yomgaqo-nkqubo wombutho, iqela okanye umbutho wezopolitiko, iziko,  
umbutho okanye iqumrhu lenkululeko kwaye ukuba uthi ewe, xela igama leqela lezpolitiko,  
umbutho, iziko, iqumrhu okanye umbutho lenkululeko:  















(b)  Ukuba kunjalo, ungazixela iinkcukacha zaloo myalelo onjalo okanye ukuvunywa okanye  
umgaqo-nkqubo kunye nomhla ngaphaya koko kunye ne(ama)gama, i(ii)dilesi, i(ii)nombolo  
yo(zo)mnxeba okanye naziphi na ezinye iinkcukacha zoqhagamshelwano zo(aba)ntu  owabika  
oko kuvuma okanye umyalelo:  











……….. 

(c) 	
Yayiyintoni injongo yezopolitiko, ukuba kukho nayiphi na, owawufuna ukuyiphumeza ngokwenza i(ama)tyala? 

(c) 	
Ingaba umbutho wakho, iziko, iqumrhu okanye umbutho wenkululeko uzuze ntoni  ekwenziweni kwe(kwama)tyala? 


Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 
……….. 


3.5 	(a) Ingaba wawuligosa/umbambi-ofisi/ilungu umxhasi wawo nawuphi na umbutho wezopolitiko/iziko/iqumrhu/umbutho wenkululeko ngexesha ekwenziwa nga(wo)lo i(ama)tyala. Ukuba kunjalo, Sesiphi isikhundla owawukuso? 
(b) 
Inombolo yobulungu, ukuba kukho nayiphi na:   

(c) 
Umhla owaba lilungu ngawo lombutho/iziko/iqumrhu okanye umbutho wenkululeko:



 ____________________________________________________________________________ 
3.6 Xela izizathu zokuba kutheni ku kuba kokulungileyo ukuba uMongameli akunike uxolelo. 
Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 
……….. 


4.1 	Ingaba wasifaka isicelo soxolelo kwi-TRC? 

4.2 	
Ukuba kunjalo, nika iinkcukacha uze unike nenombolo yesingqinisiso:  


5.1 	
Ukuba ngaba okwangoku udontsa isigwebo sakho, xela ukuba ingaba wake wafaka isicelo sengqawule na ngaphambili: 




5.2 	Ukuba ngaba isicelo sakho sokubekwa kwingqawule saliwa, nika izizathu zokuba kutheni saliwa nje isicelo sakho: 
Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 

5.3 Ukuba ngaba ukhululwa ngengqawule, loluphi ulungiselelo lokubekwa kwingqawule? (Nceda uhlomele ikopi yemiqathango yengqawule yakho) 

La maxwebhu alandelayo kufuneka ahlonyelwe kwifom yesicelo: 

(a) 	
Iseti engakhutshelwanga (original) yeempawu zeminwe. 


(b) 	
Ikopi eqinisekisiweyo yephepha lokuqala loxwebhu lwakho lwesazisi oluqinisekisiweyo. 

(c) 	
ISihlomelo A esigcwaliswe ngumbutho wezopolitiko/iziko/iqumrhu okanye umbutho wenkululeko ukuba ngaba bayasixhasa isicelo sakho. 


(d) 	
Nawaphi na amaxwebhu afumanekayo aphathelene nokubuyiselwa kwimo yangaphambili kwesimilo entolongweni kunye okanye emva kokukhululwa entolongweni. 


Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 
……….. 



*(Esi sigaba masigcwaliswe kwaye iphepha ngalinye kufakwe oonobumba kulo kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo) 
Mna ______________________________________________________________________________ (Amagama apheleleyo nefani) ndibhengeza ukuba olu lwazi lungasentla luyinene kwaye luchanekile. 
Ngolo hlobo ke isayinwe e _______________________ ngo _______ wosuku lwe _______________ unyaka 
Usayino  (Umfaki-sicelo) 
1. 	
Ingaba uyakwazi kwaye ukuqonda okuqulethwe yile ngxelo? 

Impendulo: ________________________________________ 

2. 	
Ingaba unayo nayiphi na inkcaso echasene nokuthatha isifungo esimiselweyo? 

Impendulo: ________________________________________ 

3. 	
Ingaba isifungo esimiselweyo usithatha njengesibophelelayo kwisazela sakho? 


Impendulo: ________________________________________ 

A. 	Ndiqinisekisa ukuba imibuzo ekhankanywe ngasentla ithiwe thaca kum kwaye iimpendulo zayo ke apho njengoko ziboniswe ngasentla zibhalwe ndikhona. 
___________________________________________________________      USayino loMbhengezi 

B. 	Ndiqinisekisa ukuba umbhengezi uvumile ukuba uyakwazi kwaye ekuqonda okuqulethwe kwesi sibhengezo esifungelwe phambi kwam kwaye usayino lombhengezi ke apho luye lwabekwa ndikhona. 
___________________________________________________________      UMgwebi wamaTyala amaNcinane eNkundleni UMkomishinala oFungisayo 

Amagama okuqala apheleleyo neFani_________________________________________________________ (NgoonoBumba abakhulu) 
Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 


Isikhundla (irenki) ________________________________________________________ Ngenxa yesiKhundla kwiRiphabliki yoMzantsi Afrika 
IDilesi yaseMsebenzini _____________________________________________________________________ 
(Idilesi yesitalalo kufuneka ixelwe) 
Umhla ________________________ Indawo _______________________
      OKANYE 
1. 	Ingaba ukuqinisekisa ngokusulungekileyo okuqulethwe kwesi sibhengezo? 
Impendulo _______________________________________ 

A. 	Ndiqinisekisa ukuba umbuzo okhankanywe ngasentla uthiwe thaca kum kwaye impendulo yam apho ke njengoko ibonisiwe ngasentla ibhalwe phantsi ndikhona. 
___________________________________________________________      USayino loMbhengezi 

B. 	Ndiqinisekisa ukuba umbhengezi uvumile ukuba uyakwazi kwaye ekuqonda okuqulethwe kwesi sibhengezo siqinisekiswe phambi kwam kwaye usayino lombhengezi ke apho luye lwabekwa ndikhona. 
___________________________________________________________ UMgwebi wamaTyala amaNcinane eNkundleni         UMkomishinala oFungisayo 

Amagama okuqala apheleleyo neFani_________________________________________________________ (NgoonoBumba abakhulu) 
Isikhundla (irenki) ________________________________________________________ Ngenxa yesiKhundla kwiRiphabliki yoMzantsi Afrika 
IDilesi yaseMsebenzini _____________________________________________________________________ 
(Idilesi yesitalalo kufuneka ixelwe) 
Umhla ________________________ Indawo _______________________ 
Umfaki sicela kufuneka afake oonobumba bamagama akhe kweli phepha kukho uMgwebi wamaTyala amaNcinane eNkundleni okanye uMkomishinala oFungisayo 
……….. 



