IN THE MATTER OF

a translation of a document
from the _________________language
into the ENGLISH language

I, __________________________________, of the City/Town of ________________ in

the Province of __________________________, do solemnly declare that:

1. I am sufficiently proficient in the _________________language and can read,

write and understand the same.

2. I gained my understanding of the ________________ language from __________

_________________________________________________________________.

3. I have read the document affixed hereto and marked Exhibit “A” to this, my
declaration, which is written in the _______________ Language and I have read
over the translated document which is written in the ENGLISH language, which
is marked Exhibit “B” to this my Declaration and I declare that the contents of the
document are the same as the contents of the _______________ document.

4. I make this Affidavit for the purpose of declaring that the ENGLISH translation
of this document is a faithful translation from the _______________ language.

AND I make this solemn Declaration conscientiously believing it to be true, and knowing
it is of the same force and effect as if made under oath, and by virtue of the Canada
Evidence Act.

DECLARED before me at the City/Town of }

__________ in the Province of __________ }
and Country of ________________________ } _______________________
this ___day of ____________ A.D. 20__ } (Signature of Translator)

______________________________________
A Notary Public in and for the
Province/State/Country of ________________