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SWORN DECLARATION

Mr. / Ms. .
with ID Number or Passport .

I hereby testify under oath that I have not lived or carried out main activities (studies or work)
for more than a total of 12 months over the last five years in a Programme Country (European
Union Countries plus Former Yugoslav Republic of Macedonia, Iceland, Liechtenstein, Norway
or Turkey).

In _____(city, country)_______ the __(month)__(day), __(year.)__

Signed.: .........................................................................

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