Self-Declaration

I ____________________ hereby declare that I was not involved in any SEA (Sexual Exploitation and
Abuse) case, while working with my previous employers. I do not have any reservation on reference
check from my previous employers.

Name: ___________________________________________

Position upheld at previous organization: ___________________________________________

Duration of tenure at previous organization: __________________________________________

Reference 1:

Previous employers Name: __________________________________________________

Contact No: ___________________________________________________

Email Address: ___________________________________________________

Previous Position: ___________________________________________________

Reference 2:

Previous employers Name: ___________________________________________________

Contact No: ___________________________________________________

Email Address: ___________________________________________________

Previous Position: ___________________________________________________

____________________________

Signature

Name: _______________________

Date: ________________________