Last updated 29 September 2026

How your information is handled

This notice explains what the Loss of Support Form collects, why, where it goes and what rights you have. It is written to meet section 18 of the Protection of Personal Information Act, 2013 (POPIA).

This form is different from most in one important way: it asks you about other people — the person who died, and everyone who depended on them. Section 2A sets out what that means and what you are being asked to confirm.

Before this page goes live: every item in [square brackets] must be replaced with the practice's real details. They cannot be guessed — the registered name, the physical address, and the Information Officer are specific to Dr Pretorius Inc and are required by POPIA. Delete this box once done.

1. Who is responsible for your information

Dr Pretorius Inc (“the practice”) is the responsible party. The practice decides why and how your information is used.

Registered name: [REGISTERED NAME OF THE PRACTICE]
Address: [PHYSICAL ADDRESS]
Telephone: [TELEPHONE NUMBER]
Information Officer: [NAME], [EMAIL ADDRESS]

The form itself is built and operated for the practice by Innovation for the Future Consultants (IFTFC), which acts as an operator under POPIA — it processes your information only on the practice's instruction and may not use it for anything else. What IFTFC can and cannot see is set out in section 5.

2. What the form collects

Twenty sections, and you choose how much to complete. Only the fields marked as required must be filled in.

About you — your name, date of birth, citizenship, identity or passport number, contact details, home address, your relationship to the person who died, and the capacity in which you claim.
The deceased — their name, dates of birth and death, time of death, identity number, gender, country of birth and of residence, and home address.
Every dependant — for each one: name, date of birth, identity number, ethnic group, country of birth and of residence, gender, relationship to the deceased, marital status, and why they depended on the deceased.
The accident — how the deceased came to be involved, the date, time and place, how it happened, the other driver and vehicle, the police station, case number and inquest, and any witnesses.
Support and loss — the deceased's schooling and work history, what they earned, what they paid for, how the household has managed since, the medical treatment they received and the cause of death, the funeral and its cost, and any insurance or benefit already paid.
Evidence you choose to attach — the death certificate and other documents, photographs, a sketch of the scene, and your signature.

Special personal information

Three things on this form are special personal information under section 26 of POPIA:

The ethnic group of each dependant. Asked because the actuarial calculation of a loss of support award has historically been made on that basis and the Fund and the courts expect it to be stated. It is never required — “Prefer not to say” is a real answer and the form will still send.
Health information and the cause of death. Asked because a claim for loss of support cannot be pleaded without establishing how the person died.
Information about children. Most dependants on a form like this are minors. Section 34 of POPIA prohibits processing a child's information unless an exception applies; the practice relies on section 35(1)(a) — the consent of a competent person, which is you as the parent or guardian completing this form — and on section 35(1)(b), because it is necessary for the establishment, exercise or defence of a right or obligation in law.

For the first two, the practice processes the information because it is necessary for the establishment, exercise or defence of a right or obligation in law — the claim — under section 27(1)(b), and because you consent by signing the declaration at the end of the form.

You may leave any of these fields blank. Doing so does not stop you submitting the form, but it may mean the practice has to ask you again before it can proceed.

2A. Information about other people

Almost everything on this form is about someone other than you. Two things follow from that, and both are worth stating plainly.

The person who died

POPIA protects the personal information of a living natural person, so the details of someone who has died do not fall under the Act in the same way. That changes nothing about how they are handled here: the deceased's identity number, address, health and cause of death are treated with exactly the same confidentiality as your own, and are covered by the practice's professional duty of confidentiality in any event. [THE PRACTICE SHOULD CONFIRM THIS PARAGRAPH AGAINST ITS OWN VIEW OF POPIA.]

The dependants

The details of each dependant are personal information, and they are being collected from you rather than from them. POPIA permits collection from a source other than the data subject where it is necessary for the conduct of proceedings in a court or tribunal that have commenced or are reasonably contemplated (section 12(2)(d)(iii)), and where doing so does not prejudice their legitimate interests (sections 12(2)(c) and 18(4)(b)). A claim for loss of support is exactly such a proceeding.

By continuing you confirm two things: that you are entitled to give these details for this purpose, and that you will tell any adult dependant that you have done so. Each of them keeps every right set out in section 8 below, and may exercise it against the practice directly.

3. Why it is collected

So that Dr Pretorius Inc can prepare a report in connection with a claim for loss of support arising from the death, including any claim against the Road Accident Fund. It is not used for marketing, is not sold, and is not shared with anyone other than the recipients described below.

4. Is it voluntary?

Completing the form is voluntary. The required fields are those the practice needs to identify you and act on your matter; without them it cannot proceed. Everything else may be left blank, though gaps may mean the practice has to ask you for the same information later.

5. Where your answers go — and where they do not

This is unusual enough to be worth setting out plainly.

Nothing is stored on this website. While you fill the form in, your answers exist only in your own browser's memory. Nothing is written to cookies, local storage or any other store on your device. Closing or reloading the page discards everything, and the page warns you before that happens.
“Save progress” saves to your device, not to us. It downloads a file you keep and load back in later. It is never sent anywhere. Keeping that file safe is your responsibility — it contains your answers, including the identity numbers of everyone you have listed.
The document is assembled in your browser. When you press send, your browser builds the PDF and sends only that finished document. The website never receives your answers as separate fields it could store.
It is emailed to the practice and then it is gone from our systems. Your answers and the completed document are never written to any disk, database or log. The server keeps a short technical log of whether each send succeeded — status codes and error codes only, never your answers, your name or the document. The only copy of the document is the email in the practice's inbox.

Who processes it along the way

Who	What they do	Where
Netlify	Hosts this website and runs the code that sends the email. Does not store your answers.	United States
Resend	Delivers the email to the practice. Retains the subject line, the covering message and the attachment's file name — which include the deceased's name, your name and the reference — but not the completed document itself.	United States
IFTFC Master Console	Records only that a form was submitted and whether it arrived, and tells this form who at the practice may receive it and whether the form is open. See below.	Germany (database), United States (hosting)

What IFTFC records

After each submission this form reports five things to IFTFC's console: which form, whether it was delivered, an error code if it was not, an approximate size band for the document, and whether it was a test. The console adds two of its own that the form never sends — which practice, taken from the key the form signed with, and the date and time, taken from the database — together with a randomly generated reference for the record itself.

It does not include your name, the name of the deceased, the name of any dependant, any identity number, any contact detail, your reference, anything you wrote, any photograph, your signature, the document, or your IP address. The console's database has no field capable of holding any of them.

The console also tells this form which addresses at the practice a completed form may be sent to, and whether the form is open or temporarily paused. It cannot widen that list beyond the domains this website itself allows — that restriction is held here, on this website, and the console cannot change it.

Your IP address

Netlify sees your IP address to deliver the page and to limit how many submissions can come from one connection in an hour. It is not written to any record we keep.

6. Transfers outside South Africa

The services above operate outside South Africa, so your information crosses the border when you submit the form. This is permitted under section 72(1)(a) of POPIA because each provider is bound by contract to protect it on terms comparable to POPIA's own conditions. [THE PRACTICE SHOULD CONFIRM THIS WORDING AGAINST ITS OPERATOR AGREEMENT WITH IFTFC.]

7. How long it is kept

By the practice: [RETENTION PERIOD — the practice's own file-retention policy]
By this website: Not at all. Nothing is retained.
By the email provider: The covering email, including the deceased's name, your name and the reference, for as long as the practice's account retains it. Not the document.
By the IFTFC console: The delivery record described in section 5, for 90 days, then deleted.

8. Your rights

Under POPIA you may:

ask what personal information the practice holds about you, and be given a copy (section 23);
ask for anything inaccurate, irrelevant, excessive, out of date, incomplete, misleading or unlawfully obtained to be corrected or deleted (section 24);
object to processing on reasonable grounds (section 11(3));
withdraw your consent, though this does not undo what was lawfully done before you withdrew it.

Write to the practice's Information Officer at the address in section 1. The practice must respond within a reasonable time and may charge a prescribed fee for a copy. A dependant you have listed has these same rights and may exercise them for themselves.

9. Complaints

If you are not satisfied, you may complain to the practice's Information Officer first. You may also complain directly to:

The Information Regulator (South Africa)
Woodmead North Office Park, 54 Maxwell Drive, Woodmead, Johannesburg, 2191
010 023 5200 · 0800 017 160 (toll free)
POPIAComplaints@inforegulator.org.za
inforegulator.org.za

The Regulator asks that POPIA complaints be lodged through its eServices Portal at eservices.inforegulator.org.za, which requires registering a profile first.

10. Security

The website is served only over an encrypted connection, is not indexed by search engines, and restricts what the page is permitted to load or contact. The number of submissions from one connection is limited to deter abuse. No system is perfectly secure, but the design deliberately keeps your answers out of storage entirely, which removes the most common way information is lost.

11. Changes

If this notice changes, the date at the top changes with it. The version that applies to your submission is the one published when you submitted it.

This notice describes how the form works, accurately and in plain words. It is not legal advice, and it should be reviewed and adopted by the practice before being relied upon.

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