Statutory Declaration

I, _____________________________________ (Passport no.: _______________),

a British citizen presently of ____________________________________________

__________________________________________________ do hereby solemnly

and sincerely declare as follows: -

1. I am single in my marital status; and

2. I am not presently and have never been married either within or outside

_______________________________.

And, I make this solemn declaration conscientiously believing the same to be true
and accurate in accordance of the provisions of the Statutory Declaration Act 1960.

Subscribed and solemnly )

Declared by the said )

________________ )

At ______________ )

On this ___ day of _________, ____ )