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‘STATE UNDER OATH | SOLEMNLY DECLARE IN ENGLISH:
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“tknow ond understand the content ofthis statement
“Unvave / have no objection to taking the prescribed oath |
‘Tensider donot consider the oath tobe binding on my ecisclonce Meenas;
{cert thet the above statoment was taken by the me, and thatthe depénent has acknowledged that HefShe knows and understan
ontents ofthis statement. This statement wes sworn io /afrmed before me and ie depanent’s
Signature / mark / thumbprint was placed before my presence.
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