1055

Form No. 1
Declaration as to Birth Date
I ... residing at ... do solemnly, declare and say as follows :
1. I am the mother of Mr. A who was born at ... on the day of ...
2. I am informed that the birth certificate of the said A is not avail-
able or traceable and, therefore some evidence of the birth date of Mr. A
is required by the Purchaser Mr. ... who intends to purchase the property
belonging to me and my son Mr. A and who wants some evidence to show
that the said Mr. A has attained majority.
3. I, as the mother of the said A confirm the said date of birth of the
said A and I say that the said A is now ... years old and is a major. The
birth of the said Mr. A took place in a village and I am informed that no
birth certificate is available.
4. I say that what is stated above is true to my own knowledge and
is stated conscientiously and honestly and knowing full well that relying
on the said representation the said purchaser has agreed to purchase the
said property and which is described in the Schedule hereunder written.
THE SCHEDULE ABOVE REFERRED TO
x x x x
Solemnly declared at ... )
this ... day of ... )
Identified by :
_________