DATE OF BIRTH AFFIDAVIT
I, __________, __________, resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:
- 1. WHOSE DATE OF BIRTH
- 2. THE DATE OF BIRTH
- 3. PURPOSE
- 4. DECLARATION
4.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material to this affidavit. I am aware that making a false declaration in an affidavit is an offence.
VERIFICATION
DEPONENT
Signature: ______________________________
__________
ATTESTATION
Notary Public / Oath Commissioner
Registration No. and seal: ____________________