SAMPLE. Disclaimer: This sample completed form does not necessarily cover all scenarios that are catered for by the form. Western Cape / Wes-Kaap

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Disclaimer: This sample completed form does not necessarily cover all scenarios that are catered for by the form. Western Cape / Wes-Kaap CA1234567890123 IN THE HIGH COURT OF SOUTH AFRICA Cape Town High Court Cape Town 2 0 1 5-0 4-1 4 Honourable Judge Tyson Mike In the matter between: Little Big Investment, 1st Applicant SAMPLE John Doe, 1st Respondent #

Disclaimer: This sample completed form does not necessarily cover all scenarios that are catered for by the form. Having heard counsel for the Plaintiff and having read the documents filed of record, it is hereby ordered that summary judgment is granted against the Defendant for the following: 1.Payment of the sum R983.98 (together with insurance premiums in the amount of R12.86 and assurance premiums in the amount of R58.19); 2.Interest on the sum in paragraph 1 above at the rate of 16% per annum from 23 January 2015 to date of payment; 3.An order declaring the following property specially executable; Erf 46720, Timbuktu, in the city of Cape Town, Division Cape, Western Cape Province, measuring 102 square metres in extent, held by Deed of Transfer No. T140040/1932. 4.Authorising the issuing of a writ in execution; 5.Costs of suit. By Order of Court. Court Registrar. 198 Mufasa Inc. SAMPLE 2 0 1 5-0 5-2 2

STAATSKOERANT, 22 MEI 2015 No. 1 COHC ORDERS OF THE COURT BEVELE VAN DIE HOF WESTERN CAPE / WES-KAAP Case No: CA1234567890123 IN THE HIGH COURT OF SOUTH AFRICA (Cape Town High Court) Cape Town, 14 April 2015, Honourable Judge Tyson Mike In the matter between: Little Big Investment, 1st Applicant and John Doe, 1st Respondent Having heard counsel for the Plaintiff and having read the documents filed of record, it is hereby ordered that summary judgment is granted against the Defendant for the following: 1. Payment of the sum R983.98 (together with insurance premiums in the amount of R12.86 and assurance premiums in the amount of R58.19); 2. Interest on the sum in paragraph 1 above at the rate of 16% per annum from 23 January 2015 to date of payment; 3. An order declaring the following property specially executable; 3 Erf 46720, Timbuktu, in the city of Cape Town, Division Cape, Western Cape Province, measuring 102 square metres in extent, held by Deed of Transfer No. T140040/1932. 4.Authorising the issuing of a writ in execution; 5. Costs of suit. By Order of Court. Court Registrar. 198 Mufasa Inc. This gazette is also available free online at www.gpwonline.co.za

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