A CERTIFIED DECLARATION

IN RESPECT OF LITIGATION HISTORY

I,xxxxxxxxxxxxxxxxxxxxxxxxxxan adult and of P.O Box 912, Dodoma, DOHEREBY
AFFIRM and DECLARE as follow.
1. That, I am Tanzanian and naturally residing in Dodoma;

2. That, I certify and declare that, I have no contractual litigation against the
government or any government authority or authorities.

3. That, I make this declaration concisely believing the same to be true by virtue of
The Oath and Statutory Declaration Act [CAP 34 R.E 2019].

AFFIRMED at DODOMA by the said

xxxxxxxxxxxxxxxxxxxxxxxxxx who is
known to me personally/identified to me by….… ……………………
the latter being known to me in my presence DECLARANT
this…………….… day of ………………. 2021.

BEFORE ME:

NAME:………………………………….……….

SIGNATURE:………………….……..………...

POSTAL ADDRESS:………………………….

QUALIFICATION:……………………………

DRAWN BY:

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