‘SOUTH AFRICAN POLICE SERVICE GAUTENG PROVINCE
PRO FORMA STATEMENT PAGE 1 OF 2
rurnamesavosumane: Luan Bacana ANwAPo
WITH 10 NUMBER OR DATE OF BIRTH; 1303055 21 TOF poe: SO anocontact nr: OF Soz 2654
resiowe at: REIORIA
EMPLOYED AS A/AN : ATS
DECLARES UNDER OATH | AFFIRMS AS FOLLOWS (Dolote thet which ls not applicable)
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PRO FORMA STATEMENT PAGE 2 OF 2
FULL NAMES AND SURNAME:
DECLARES FURTHER UNDER OATH / AFFIRMS FURTHER AS FOLLOWS (Delete tht which
T TENG
UKNOW AND UNDERSTAND
HAVE NO OBJECTION || OBJECT TO TAKING THE PRESCRIBED OATH
PRESCRIBED OATH TO BE BINDING ON MY CONSCIENCE
CONSIDER / | DO NOT CONSIDER THE
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[RETIALS AND SURNAME OF SAPS EMPLOYEE TAKING. waren LV Ta tielin 2 RANK: $2
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