THEBOLO E E FAPHEGILENG YA BOITSHWARELO JWA PORESITENTE TEBANG LEMOLATO/MELATO E GO TWENG E DIRILWE GO FITLHELELA MAIKAELELO A SEPOLOTIKI 
DIPOTSO TSOTLHE DI TSHWANETSE GO LEBISIWA GO:   RRE N. GAWULA DEPARTMENT OF JUSTICE AND CONSTITUTIONAL DEVELOPMENT MOGALA: 012-357 8573 / 8626 FEKESEX: 0866 193 443 SELE: 082 466 8968 

1.1	DINTLHA TSA SEBELE Sefane: _____________________________________________________ Maina ka botlalo (jaaka a kwadilwe mo lekwalokaong (ID) la gago):   
Nomore ya ID: _____________________________________________________ 
1.2	DINTLHA TSA KGOLAGANA: 
1.2.1 Aterese ya poso:  ___________________________________________      ___________________________________________     ___________________________________________Aterese ya bonno:  ___________________________________________  
    ___________________________________________     ___________________________________________ 
1.2.2 	Dintlha tsa kgolegelo, fa go lebane:   Nomore ya kgolegelo: _____________________________________________ Letlha la ntlhantlha le ka lona o tshwanelang go fiwa parole: ____________________ Letlha la tlwaelo la kgololo: ______________________________________________ Dikhoso tsa Tsosoloso-maitsholo tse di tseneletsweng ka nako ya kgolego:   
 ____________________________________________________________________  ____________________________________________________________________ ____________________________________________________________________ 



2. 



DINTLHA TSA MOLATO/MELATO E E KOPELWANG BOITSHWARELO

MOLATO (LEINA LA MOLATO, SEKAO, POLAO) (Kwala molato mongwe le mongwe ka sengwe  each offence separately)  LETLHA LA MOLATO  LEFELO LE MOLATO O DIRILWENG KWA GO LONE  LETLHA LA PONOMOLATO  KGOTLA  NOMORE YA KGETSI  KATLHOLO  


















This page must be initialed by applicant in presence of a Justice of the Peace or a Commissioner of Oath 
(If space provided is insufficient, please attach further information on a separate sheet of paper) 

…….. Initial 
3. DINTLHA KA MOLATO/MELATO LE MABAKA A GO DIRA KOPO

3.1	Fa dintlha tse di latelang:   
3.1.1	Molato kgotsa melato e dirilwe jang (dintlha tsa gore go dirafetse eng ka nako ya fa molato/melato e dirwa)):   
3.1.2	Ke eng go dirilwe molao kgotsa melato e:   



3.2	A go na le motho yo o gobetseng kgotsa yo o bolailweng kgotsa a go na le mongwe yo o neng a senyegelwa ke dithoto ka ntlha ya molato le bogolo ba kgobalo epe le kgotsa tshenyo, gape fana ka dintlha tsa kgolagano tsa batswasetlhabelo, fa di le teng:   
3.3	(a) A o ne wa sologelwa ka sebele ka tsela epe ka ntlha ya go dira molao/melato?   



(b) 
Fa go le jalo, tlhalosa mofuta le bogolo jwa mesola / melemo eo.    

(c) 	
Ke maikaelelo afe a sepolotiki, fa a le teng, a o neng o batla go a fitlhelela ka go dira molato/melato e?   

(d) 	
A mokgatlho, setheo, lekgotla kgotsa lekoko la kgololesego la gago le amogetse mesola mengwe ka ntlha ya go dirwa ga melato e?   





3.4  (a)  A molato kgotsa melato e dirilwe go setswe morago taolo ya, kgotsa ka thebolelo ya, kgotsa ka   
tetla kgotsa tebang le pholisi (molaotsamaiso) ya lekgotla, lekoko kgotsa lekgotla la sepolotiki,  
setheo, mokgatlho kgotsa lekoko la kgololesego, le gone fa go le jalo, fana ka leina la lekoko la  
sepolotiki, lekgotla, setheo, mokgatlho wa kgololesego:     










(b)  Fa go le jalo, o ka bolela dintlha tsa taolo eo kgotsa thebolo kgotsa pholisi le letlha la yona le  
leina/maina, diaterese, dinomore tsa megala kgotsa dintlha tse dingwe tsa kgolagano tsa motho  
kgotsa batho ba ba fileng thebolo kgotsa taolo ya go nna jalo:    





















3.5 	(a) A o ne o le motlhankedi / motshwaramaemo/tokololo/morotloetsi wa lekoko lepe la sepolotiki/setheo/lekgotla/lekgotla la kgololesego ka nako e go neng go dirwa molato kgotsa melato e? fa go le jalo, o ne o dira o le mo maemong afe?   
(b) 
Nomore ya botokololo, fa e le teng:  ________________________________________ 

(c) 
Letlha le o nnileng tokololo ya lekgotla/setheo/mokgatlho kgotsa lekoko la kgololesego:   


3.6 
Bolela mabaka gore go tla siamela setšhaba jang gore Poresitente a go itshwarele.   

4.1	
A o kopile boitshwarelo mo TRC?   






4.2	
Fa go le jalo , fa dintlha tsa nomore ya referense ya TRC:    

5.1	
Fa e le gore ga jaana o diragatsa katlholo, boela gore a o kile wa kopa parole mo lobakeng lo lo fetileng:    



5.2	Fa kopo ya gago ya go bewa mo paroleng e gannwe, fa mabaka a gore ke eng kopo ya gago e gannwe: 



5.3 Fa o gololwa ka parole, ke melawana efe e e laolang go fiwa parole?   (Tsweetswee mametlelela khopi ya mabaka a gago a parole)   

Ditokomane tse di latelang di tshwanetse go mametlelediwa mo foromong ya kopo:  
(a)	
Kgatiso ya mmatota ya menwana ya gago. 

(b)	
Khopi e e rurifaditsweng ya tsebe ya ntlha ya lekwalokaong (ID) la gago.   

(c)	
Mametlelelo A e e tladitsweng ke lekgotla/setheo/mokgatlho/lekoko la kgololesego, fa e le gore le etleetsa kopo ya gago.    

(d)	
Mokwalo ope o o leng teng tebang le kagoseswa ya botho (rehabilitation). 






*(Karolo e e tshwanetse go tladiwa le gore ditlhakaina di kwalwe mo tsebeng nngwe le nngwe fa pele ga, le gone ke Justice of the Peace kgotsa Mokomisinara wa Ikano) 
Nna ____________________________________________________________________________ Maina ka botlalo le sefane) ke bolela gore tshedimosetso e e fa godimo e boammaaruri e bile e nepagetse.  
Go sainilwe jaana kwa ______________________________________ ka letsatsi la _______ la kgwedi ya 
_______________ ka ngwaga wa ______ 
Tshaeno (Mmoledi)   
1. 	
A o tlhaloganya diteng tsa polelo e?   

Karabo: ________________________________________ 

2. 	
A o na le kganetso epe kgatlhanong le go dira maikano a a filweng?   

Karabo: ________________________________________ 

3. 	
A o tsaya maikano a a beilweng a tlama segakolodi sa gago?   


Karabo: ________________________________________ 
A. 	Ke rurifatsa gore ke boditswe dipotso tse di umakiliweng fa godimo le gore dikarabo tsa tsona jaaka di kwadilwe fa godimo di kwadilwe ke le teng.   
  ___________________________________________________________      Tshaeno a Mmoledi 
B. 	Ke rurifatsa gore mmoledi o dumetse gore o itse e bile o tlhaloganya diteng tsa polelo eno, e a ikanneng ka yona fa pele ga me, e bile tshaneo ya Mmoledi e ne ya bewa mo go yone fa pele ga me.   
  ___________________________________________________________      Justice of the Peace  Mokomisenara wa Ikano 
Maina a ntlha ka botlalo le Sefane ____________________________________________________________ (Ditlhakakgolo) 



Maemo ________________________________________________________  Maemo mo Repaboliki ya Afoprika Borwa   Aterese ya kwa Tirong _____________________________________________________________________ (Go tshwanetse ga fiwa aterese ya mmila)   Letlha ________________________ Lefelo _______________________ KGOTSA 
1. 	A o tlhomamisa ka bomasisi diteng tsa polelo e?   Karabo _______________________________________ 
A. 	Ke rurifatsa gore ke boditswe dipotso tse di umakiliweng fa godimo le gore dikarabo tsa tsona jaaka di kwadilwe fa godimo di kwadilwe ke le teng.   
  ___________________________________________________________      Tshaeno ya Mmoledi 
B. 	Ke rurifatsa gore mmoledi o dumetse gore o itse e bile o tlhaloganya diteng tsa polelo eno, e e tlhomamisitsweng fa pele ga me, e bile tshaneo ya Mmoledi e ne ya bewa mo go yone fa pele ga me.   
  ___________________________________________________________      Justice of the Peace  Mokomisenara wa Ikano   
Maina a ntlha ka botlalo le Sefane ____________________________________________________________ (Ditlhakakgolo) Maemo ________________________________________________________  Maemo mo Repaboliki ya Afoprika Borwa   
Aterese ya kwa Tirong _____________________________________________________________________ 
(Go tshwanetse ga fiwa aterese ya mmila)   
Letlha ________________________ Lefelo _______________________ 




