THE REPUBLIC OF UGANDA

IN THE MATTER OF THE STATUTORY DECLARATION ACT CAP 22

AND
IN THE MATTER OF AN APPLICATION FOR ISSUANCE OF SINGLE STATUS LETTER
OF
[Insert names of Applicant]

STATUTORY DECLARATION

I,[Insert Applicant’s name] resident of ………….. [Insert village and District] do

hereby declare and state as follows;

1 That I am a ………………… [Applicant’s sex] Ugandan adult citizen, of

sound mind and an applicant herein and swear this affidavit in that
capacity.
2 That I was born on ………………………. [MM/DD/YY] at……………….;
[Hospital/any other place] to………………….[father’s name]
and…………………………….. [Mother’s name].
3 That I am……..…………………..[insert current marital status;
[single/divorced/widowed] and I have never contracted any marriage
with any person in Uganda or any part of the world.
4 That there is no impediment of kindred or affinity or any lawful hindrance
to the intended marriage.
5 That I make this declaration verily knowing and believing the contents
to be true and correct to the best of my recollection and information as
disclosed.

Dated at Kampala this……………….day of ……………..……………20……..

Sworn by the said

……………………………… ………………………[signature]
Declarant
Before me
……..……………………………….
Commissioner for oaths

Drawn By;
…………………………………
…………………………………
 THE REPUBLIC OF UGANDA

IN THE MATTER OF THE STATUTORY DECLARATION ACT CAP 22

AND
IN THE MATTER OF ISSUANCE OF SINGLE STATUS LETTER OF
[Insert name of Applicant]
STATUTORY DECLARATION

I, ……………………………………… [name of Parent/guardian] resident of ……………

[village]and
[District] do hereby declare and state as follows;
1. That I am a [insert sex] Ugandan adult citizen, of sound mind and an
applicant herein and swear this affidavit in that capacity.
2. That am the ……………….[relationship with the Applicant] to the
Applicant, born on… … … … … … … … … … [Applicant’s Date of Birth as
MM/DD/YY] at……………………………………….[Applicant Place of Birth] .
3. That my…………………………… [relationship with the Applicant] is
SINGLE has never contracted any marriage with any person in Uganda
or any part of the world.
4. That there is no impediment of kindred or affinity or any lawful hindrance
to the intended marriage.
5. That I make this declaration verily knowing and believing the contents
to be true and correct to the best of my recollection and information as
disclosed.

Dated at Kampala this……………….day of ………………………20…....

Sworn by the said;

………………………………………. …………………………………..
Declarant
Before me
……..……………………………….
Commissioner for oaths

Drawn By;
………………………………….
………………………………….