Forms and Documents

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Authorisation



I, the undersigned,

(FULL NAMES AND IDENTITY NUMBER/BIRTH DATE)

do hereby authorise:

to furnish Austin-Jordaan Attorneys, the Road Accident Fund, and/or their duly authorised Agents in writing with all and any medical reports, x-ray photographs, accounts, bed-letters or other documentary information that they may require to enable them to pursue a third party claim on behalf of

(FULL NAMES AND IDENTITY NUMBER/BIRTH DATE OF INJURED PARTY)

for injuries suffered by him/her on the day of 199 /200 .

Dated at on this the day of 200

AS WITNESSES:





1.________________________

2.________________________ Sgd______________________

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