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.