SCHEDULE

FORM OF STATUTORY DECLARATION.

I, A. B., do solemnly and sincerely declare that:—

and I make this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declarations Act, 1938 .

(Signed) A. B.

Declared before me by A. B.

who is personally known to

me (or who is identified to

me by C. D. who is personally

known to me) at

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this ................................. day of ...................................................

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