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Doc NO:
LR 12
Revision:
1
Next Revision: Jan 2026
Controlled by:
Authorised by:
Subject: Voluntary Truth Verification Test
Employee Number: ___________
ID: ______________
Employee name: __________________________________
Position: _______________
Time: ____________
Date: ___/___/2026
1: I understand and authorize the service provider to share the outcome/finding with my Employer and give consent that my Employer may contact the service provider, who tested me or issued such notice.
2: I give authorization to my Employer to book an appointment with any officer or service provider and I undertake to submit myself promptly to such testing.
3: I understand and authorize the service provider to share the outcome/finding with my Employer and give consent that my Employer may contact the service provider, who tested me or issued such notice.
4: This is in line with my contract of employment “The Employee undertakes to subject himself/herself to a truth verification process, or testing with apparatus specifically designed for the purpose in the case of suspicion by the Employer or supervisor that the Employee is not truthfull."
5: I hereby declare that I understand and agree that this information may be stored, filed, shared and processed with individuals who will use it in line with their business function in terms with the Protection of Personal Information Act 4 of 2013.
2: I give authorization to my Employer to book an appointment with any officer or service provider and I undertake to submit myself promptly to such testing.
3: I understand and authorize the service provider to share the outcome/finding with my Employer and give consent that my Employer may contact the service provider, who tested me or issued such notice.
4: This is in line with my contract of employment “The Employee undertakes to subject himself/herself to a truth verification process, or testing with apparatus specifically designed for the purpose in the case of suspicion by the Employer or supervisor that the Employee is not truthfull."
5: I hereby declare that I understand and agree that this information may be stored, filed, shared and processed with individuals who will use it in line with their business function in terms with the Protection of Personal Information Act 4 of 2013.
Follow-up date: ___/___/2026
Employee's signature: ____________________
Witnes: ____________________
Date: ___/___/2026