PwC Immigration Questionnaire

Please complete in full using BLOCK LETTERS.

SECTION A: MAIN APPLICANT ONLY
Personal Details:
Name and surname

Fabio Miguel de Carvalho e Silva

Marital Status***

Single

*** If married, a copy of the marriage certificate is required.

*** If divorced, a copy of the Divorce Decree/Order is required.
***If in Legal Partnership, proof the partnership is required (please discuss with PwC if this is applicable).

Citizenship Details
Present Country of citizenship

Mozambique

Do you hold any other citizenship

No

If yes, please indicate which country

How did you obtain citizenship for this country?
By birth, family is Mozambican

South African Assignment Details

Position / Role to commence on Assignment in
South Africa only
Detailed explanation of the job description

PricewaterhouseCoopers Tax Services (Pty) Ltd

2 Eglin Road, Sunninghill 2157, Private Bag X36, Sunninghill 2157
T: +27 (11) 797 4000, F: +27 (11) 797 5800, www.pwc.com/za
T P Blandin de Chalain National Tax Leader
The Company's principal place of business is at 2 Eglin Road, Sunninghill where a list of directors' names is available for inspection.
Reg. no. 1983/008289/07.

Home Employer Details (if applicable)

Current Position / Role at in your home country only
Date when you joined your home Employer?
Address of Employers Office in the home country

Telephone number of Employer

Addresses
Residential Address in home country

Postal Address in home country

Home Telephone Number (incl. Dialing code)

Mobile Number (incl. Dialing code)
Proposed/ Current residential address in South
Africa

Other addresses where you have lived during the last ten years other than your current address:
Address

Period

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Country

Countries where you have lived for 12 months or longer since the age of 18 years:
Please note that the duration is cumulative and not consecutive.
*** Please note that Police Clearance Certificates will be required for these countries.
Country
Period

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Security / Health

YES
Have you or any of your dependants accompanying you ever been convicted of
any crime in any country?
Is a criminal/civil case pending against you or any of your dependants
accompanying you in any country?
Are you or any of your dependants suffering from tuberculosis, any other
infectious or contagious disease or any mental or physical deficiency?
Are you an unrehabilitated insolvent?
Have you ever been judicially declared incompetent?
Are you a member of or adherent to an association or organisation advocating
the practice of social violence, or racial hatred?
Furnish full particulars if the reply to any of these questions is in the affirmative:

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NO

SECTION B: ACCOMPANYING FAMILY / DEPENDANTS (IF APPLICABLE)

Please ensure that you notify PwC of any family / dependants accompanying you.
ACCOMPANYING SPOUSE
Name and Surname
Maiden Name (if applicable)
Current residential address in Home Country /
Country of Residence

Period resident at current residential address

Period resident in the country
Telephone Number (Home)
Occupation or Profession

Countries where you have lived for 12 months or longer since the age of 18 years:
Please note that the duration is cumulative and not consecutive.
*** Please note that Police Clearance Certificates will be required for these countries.
Country
Period

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Security / Health
YES
Have you or any of your dependants accompanying you ever been convicted of
any crime in any country?
Is a criminal/civil case pending against you or any of your dependants
accompanying you in any country?
Are you or any of your dependants suffering from tuberculosis, any other
infectious or contagious disease or any mental or physical deficiency?
Are you an unrehabilitated insolvent?
Have you ever been judicially declared incompetent?
Are you a member of or adherent to an association or organisation advocating
the practice of social violence, or racial hatred?
Furnish full particulars if the reply to any of these questions is in the affirmative:

6 of 7

NO

ACCOMPANYING CHILD (1)

Name and Surname
Maiden Name (if applicable)
Current residential address in Home Country /
Country of Residence

Period resident at current residential address

Period resident in the country
Telephone Number (Home)
Occupation or Profession

ACCOMPANYING CHILD (2)

Name and Surname
Maiden Name (if applicable)
Current residential address in Home Country /
Country of Residence

Period resident at current residential address

Period resident in the country
Telephone Number (Home)
Occupation or Profession

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