AFFIDAVIT

I, DAMAS DAMAS KOMBA adult Christian and resident of Peramiho Songea, of P. O. Box
Peramiho, do hereby solemnly and sincerely affirm and state as follows;-

1. That I am a Tanzanian citizen and a holder of Passport Number AB 115426 issued by PCO
Dar es Salaam, on 26th January 2006.

2. That sometimes on November 2008 while traveling to Makonde via Lake Nyasa the Vessel
we were using involved in an accident where was about to sink.

3. That the said Passport drifted in Lake Nyasa as a result of the accident and was damaged.

4. That I reported the loss of the Passport to the Police Force and could not be found by any
means since was taken by the water in Lake Nyasa and in anyway the said passport got
damaged.

5. That following that situation I am now applying to be issued with a new Passport by your
Authority.

6. That I am making this affidavit / declaration conscientiously believing the same to be true and
in accordance with the provisions of the The Oaths and Statutory Declarationsl Act [Cap 34
R.E 2002].

Dated and Sworn at Dar es Salaam this .................. day of .....................................2010.

Sworn at Dar es Salaam by the said

DAMAS DAMAS KOMBA who is ………………………………………
known to me personally /introduced to DAMAS DAMAS KOMBA
me by ……………………………………….
this ………..day of……….2010

BEFORE ME:-

__________________________
COMMISSIONER FOR OATHS