Last Updated: Friday, 11 July 2014, 13:14 GMT

Uganda Citizenship Act, 1962

Publisher National Legislative Bodies
Author Uganda
Publication Date 9 October 1962
Reference UGA-130
Cite as Uganda Citizenship Act, 1962 [],  9 October 1962, available at: http://www.refworld.org/docid/3ae6b4d23c.html [accessed 11 July 2014]
Comments This is the official consolidation as published in the "Laws of Uganda", Volume II, pages 892-912, revised edition 1964. The Amendments included here are Act 57 of 1963, Act 84 of 1963, and S.I. 166 of 1964.
DisclaimerThis is not a UNHCR publication. UNHCR is not responsible for, nor does it necessarily endorse, its content. Any views expressed are solely those of the author or publisher and do not necessarily reflect those of UNHCR, the United Nations or its Member States.

An Act To Make Provision For The Acquisition Of Citizenship Of Uganda By Registration In Certain Cases, To Regulate The Manner And Circumstances In Which Aliens May Be Naturalized As Citizens Of Uganda And In Which Citizens Of Uganda May Renounce Or Be Deprived Of Their Citizenship, And To Make Provision For Certain Other Matters Relating To Citizenship Of Uganda And For Matters Incidental To And Connected With The Aforesaid Purposes.

PART I-PRELIMINARY.

1. Short title

[Omitted-Acts of Parliament Act, section 12.]

2. Interpretation.

(1) In this Act, unless the context otherwise requires-

"alien" means a person who is not a Commonwealth citizen, a protected person or a citizen of the Republic of Ireland;

"certificate of naturalization" means a certificate of naturalization granted under this Act;

"Commonwealth" means Uganda, any country to which section 13 of the Constitution applies and any dependency of any such country;

"foreign country" means a country (other than the Republic of Ireland) that is not part of the Commonwealth;

"minor' means a person who has not attained the age of twenty-one years;

"protected person" means any person who, under any enactment for the time being in force in any country that is part of the Commonwealth, is a British protected person of that country;

"Uganda Consulate" means an office of a consular officer of the Government of Uganda where a register of births or residents is kept or, where there is no such office, such office as may be prescribed.

(2)For the purposes of this Act, a person born aboard a registered ship or aircraft or aboard an unregistered ship or aircraft of the government of any country, shall be deemed to have been born in the place in which the ship or aircraft was registered or, as the case may be, in that country.

(3)A person shall, for the purposes of this Act, be of full age if he has attained the age of twenty-one years, and of full capacity if he is not of unsound mind.

(4)For the purposes of this Act, a person shall be deemed not to have attained a given age until the commencement of the relevant anniversary of the day of his birth.

PART II-REGISTRATION AND NATURALIZATION.

3. Registration of Commonwealth citizens, citizens of the Republic of Ireland, protected persons, and children of citizens by descent.

(1)Subject to the provisions of subsection (3) of this section, a citizen of any country to which section 13 of the Constitution applies or of the Republic of Ireland or a protected person, being a person of full age and capacity, on making application therefor to the Minister in the prescribed manner, may be registered as a citizen of Uganda if he satisfies the minister-

(a)that he is ordinarily resident in Uganda, and has been so resident for a period of five years; and

(b)that he has an adequate knowledge of a prescribed vernacular language or of the English language;

(c)that he is of good character; and

(d)that he would be a suitable citizen of Uganda.

(2)Subject to the provisions of subsection (3) of this section, any person of full age and capacity born outside Uganda whose father was at the time of that person's birth a citizen of Uganda by virtue of subsection (2) of section 7 of the Constitution or by virtue of section 10 of the Constitution may, on making application therefor to the Minister in the prescribed manner, be registered as a citizen of Uganda.

(3)A person shall not be registered as a citizen of Uganda under this section unless and until he has made a declaration in writing in the prescribed form of his willingness to renounce any other nationality or citizenship he may possess and to take an oath of allegiance in the form specified in the First Schedule to this Act.

3A. Women entitled to be registered as citizens.
[Added Act 84 of 1963, s. 2.]

Notwithstanding any other provision of this Act any woman who, on the 8th day of October, 1962, was married to a person who becomes a citizen of |Uganda by virtue of the provisions of subsection (5) of section 8 of the Constitution shall, on making application therefor in the prescribed manner, be entitled to be registered as a citizen of Uganda.

4. Registration of citizens of certain African states.

(1)Subject tot he provisions of subsection (2) of this section, a citizen of any state to which this section applies, being a person of full age and capacity, on making application therefor to the Minister in the prescribed manner, may be registered as a citizen of Uganda if he satisfies the minister-

(a)that he is ordinarily resident in Uganda and has been so resident for a period of five years; and

(b)that he has an adequate knowledge of a prescribed vernacular language or of the English language;

(c)that he is of good character; and

(d)that he would be a suitable citizen of Uganda:

Provided that the Minister may, by statutory order, waive or vary the requirement set out in paragraph (b) of this subsection in respect of the citizens of any state to which this section applies, where he is satisfied that any corresponding provision in the law of that state may be waived or varied in respect of citizens of Uganda.

(2)A person shall not be registered as a citizen of Uganda under this section unless and until he has made a declaration in writing in the prescribed form of his willingness to renounce any other nationality or citizenship he may possess and to take an oath of allegiance in the form specified in the First Schedule to this Act.

(3)The Minister may, where he is satisfied that reciprocal provisions are or may be made in respect of Uganda citizens under the law of any state on the continent of Africa other than a country of the Commonwealth, and that it is desirable so to do, by statutory order made with the prior approval signified by resolution of the National Assembly, declare such state to be a state to which this section applies.

5. Registration of minors.

(1)The minister may cause the minor child of any citizen of Uganda to be registered as a citizen of Uganda upon application made in the prescribed manner by a parent or guardian of the child.

(2)The Minister may, in such special circumstances as he thinks, fit, cause any minor to be registered as a citizen of Uganda.

6. Effect of registration.

(1)Subject to the provisions of subsection (2) of this section, a person registered as a citizen of Uganda under section 8 or section 11 of the Constitution or under section 3, section 4 or section 5 of this Act shall become a citizen of Uganda by registration on the date on which he is registered.

(2)If a person of full age who is registered as a citizen of Uganda under this Act does not produce to such officer as the Minister may appoint in that behalf, within three months of being so registered or within such further period as the Minister or such officer may allow, evidence sufficient to satisfy such officer that he has renounced any other nationality or citizenship which he may have possessed and that he has taken an oath of allegiance in the form specified in the First Schedule to this Act, the registration of that person as a citizen of Uganda shall be cancelled and he shall be deemed never to have been so registered.

7. Naturalization of aliens.

(1)Subject to the provisions of this section-

(a)the Minister may, if application therefor is made to him by any alien of full age and capacity who satisfies him that he is qualified under the provisions of the Second Schedule to this Act for naturalization, grant to such alien a certificate of naturalization; and

(b)the alien to whom such a certificate is granted shall become a citizen of Uganda by naturalization from the date of the grant.

(2) A certificate of naturalization as a citizen of Uganda shall not be granted under this section except to a person who, before the grant of such certificate, has made a declaration in writing in the prescribed form of his willingness to renounce any other nationality or citizenship which he may possess and to take as oath of allegiance in the form specified in the First Schedule to this Act.

(3)If a person to whom a certificate of naturalization as a citizen of Uganda has been granted under this section does not produce to such officer as the Minister may appoint in that behalf, within three months of such grant or within such further period as the Minister or such officer may allow, evidence sufficient to satisfy such officer that he has renounced any other nationality or citizenship which he may have possessed and that he has taken an oath of allegiance in the form specified in the First Schedule to this Act, the naturalization of that person as a citizen of Uganda shall be cancelled and he shall be deemed never to have been so naturalized.

7A. Residence under authority of certain passes not residence for acquisition of citizenship by registration or naturalization.
[Added Act 57 of 1963, s. 7.l]

Notwithstanding any of the provisions of this Act, or of any other law any period of residence in Uganda under the authority of any-

(a)temporary employment pass;

(b)dependant's pass to a dependant of the holder of a temporary employment pass;

(c)pupil's pass

(d)special pass;

(e)visitor's pass; or

(f)permit to a prohibited immigrant,

issued under the provisions of any regulations made under the Immigration (Control) Act, whether such pass or permit was issued before of is issued after the 1st October, 1963, shall not be included in the aggregate of years of residence for the purpose of the acquisition of citizenship by naturalization or registration under this Act.

PART III-RENUNCIATION AND DEPRIVATION.

8. Renunciation of citizenship.

(1)If any citizen of Uganda of full age and capacity who is also-

(a)a citizen of any country to which section 13 of the Constitution applies, or of the Republic of Ireland; or

(b)a national of a foreign country,

makes a declaration in the prescribed manner of renunciation of citizenship of Uganda, the minister may cause the declaration to be registered; and upon registration, that person shall cease to be a citizen of Uganda.

(2)The Minister may refuse to register any declaration of the kind mentioned in subsection (1) of this section if it is made during any war in which Uganda may be engaged or if, in his opinion, it is otherwise contrary to public policy; but notwithstanding the refusal of the Minister, a person who makes any such declaration shall cease to be a citizen of Uganda at the time prescribed in section 12 of the Constitution.

9. Deprivation of citizenship of persons who exercise certain rights in other countries.

The Minister may by order deprive any person, other than a person who is a citizen of Uganda by virtue of subsection (1) of section 7 of the Constitution or by virtue of section 9 of the Constitution, of his Uganda citizenship if the Minister is satisfied that that person has at any time while a citizen of Uganda and of full age and capacity voluntarily claimed and exercised-

(a)in a foreign country; or

(b)in any other country under the law of which provision is in force for conferring on its own citizens rights not available to Commonwealth citizens generally,

any right available to him under the law of that country, being a right accorded exclusively to its own citizens, and that it is not conducive to the public good that he should continue to be a citizen of Uganda.

10. Deprivation of citizenship of citizens by registration or naturalization.

(1)Subject to the provisions of this section, the Minister may be order deprive of his citizenship any citizen of Uganda who is such by registration if he is satisfied that the registration or certificate of naturalization was obtained by means of fraud, false representation or the concealment of any material fact.

(2)Subject to the provisions of this section, the Minister may be order deprive of his citizenship any citizen of Uganda who is such by naturalization if he is satisfied that that citizen-

(a)has shown himself by act or speech to be disloyal or disaffected towards the Government of Uganda; or

(b)has, during any war in which Uganda was engaged, unlawfully traded or communicated with any enemy or been engaged in or associated with any business that was to his knowledge carried on in such a manner as to assist an enemy in that war; or

(c)has, within seven years after becoming naturalized, been sentenced in any country to imprisonment for a term of not less than twelve months; or

(d)has been ordinarily resident in foreign countries for a continuous period of seven years and during that period has not registered annually in the prescribed manner with a Uganda consulate, or by notice in writing to the Minister, his intention to retain his citizenship of Uganda.

(3)The Minister shall not deprive a person of citizenship under this section unless he is satisfied that it is not conducive to the public good that that person should continue to be a citizen of Uganda.

(4)Before making an order under this section, the Minister shall give the person against whom the order is proposed to be made notice in writing informing him of the ground on which it is proposed to be made and of his right to an inquiry under this section; and if that person applies in the prescribed manner for an inquiry, the minister shall refer the case to a committee of inquiry consisting of a chairman, being a person possessing judicial experience, appointed by the Minister and of such other members appointed by the Minister as he thinks proper.

11. Deprivation of citizenship of Uganda when person deprived of citizenship elsewhere

(1)Where a citizen of Uganda who is such by registration-

(a)was a citizen of any country to which section 13 of the Constitution applies or of the Republic of Ireland, or of any country to which section 4 of this act applies, by virtue of a certificate of naturalization granted to him or in which his name was included; and

(b)has been deprived of that citizenship on grounds which in the opinion of the minister are substantially similar to any of the gr0ounds specified in subsections (1) and (2) of section 10 of this Act, the Minister may by order deprive him of his Uganda citizenship, if the minister is satisfied that it is not conducive to the public good that that person should continue to be a citizen of Uganda.

(2)Before making an order under this section, the Minister shall give the person against whom the order is proposed to be made notice in writing informing him of the ground on which it is proposed to be made and may refer the case to a committee of inquiry constituted in the manner provided by section 10 of this Act.

12. Effect of renunciation or deprivation.

(1)A citizen of Uganda who is deprived of his citizenship by an order of the Minister under section 9, section 10 or section 11 of this Act shall, upon the making of the order, cease to be a citizen of Uganda.

(2)The renunciation by any person of his Uganda citizenship or the deprivation of any person's Uganda citizenship under the provisions of this Part of this act shall not affect the liability of that person for any offence committed by him before the renunciation or deprivation of his citizenship.

PART IV-SUPPLEMENTAL.

13. Married women.

For the purposes of Parts II and III of this Act, any woman who has been married shall be deemed to be of full age.

14. Legitimated children.

(1)A person born out of wedlock and legitimated by the subsequent marriage of this parents shall, as from the date of the marriage or of the commencement of this Act, whichever is later, be treated, for the purposed of determining whether he is a citizen of Uganda, as if he had been born legitimate.

(2)A person shall be deemed for the purposes of this section to have been legitimated by the subsequent marriage of his parents if by the law of the place in which his father was domiciled at the time of the marriage the marriage operated immediately or subsequently to legitimate him, and not otherwise.

15. Posthumous children.

Any reference in this Act to the national status of the father of a person at the time of that person's birth shall, in relation of a person born after the death of his father, be construed as a reference to the national status of the father at the time of the father's death; and where that death occurred before the 9th October, 1962, and the birth occurred after the 8th October, 1962, the national status that father would have had if he had died on the 9th October, 1962, shall be deemed to be his national status at the time of his death.

16. Decision of minister to be final.

The Minister shall not be required to assign any reason for the grant or refusal of any application under this Act and the decision of the Minister on any such application shall not be subject to appeal to or review in any court.

17. Certificate of citizenship in cases of doubt.

The Minister may in such cases as he thinks fit, on the application of any person with respect to whose citizenship of Uganda a doubt exists, whether on a question of fact or law, certify that that person is a citizen of Uganda; and a certificate issued under this section shall, unless it is proved that it was obtained by means of fraud, false representation or concealment of any material fact, be conclusive evidence that that person was such a citizen on the date thereof, but without prejudice to any evidence that he was such a citizen at an earlier date.

18. Manner of making applications.

(1)Every application under section 8 or section 11 of the Constitution shall be made to the Minister.

(2)Every application to the Minister under section 8 or section 11 of the Constitution, or under this Act-

(a)shall be accompanied by the prescribed fee, if any;

(b)where the form of any such application is prescribed under this Act, shall be made in such form with such variations as the circumstances may require and the minister accepts;

(c)shall be supported by such evidence of the statements made therein as may be prescribed under this Act or as the Minister may require; and

(d)shall be verified by an affidavit or a declaration made before a magistrate or commissioner for oaths.

19. Renunciation of citizenship of other countries and declarations relating to residence.

(1)Were, under Chapter II of the Constitution or the foregoing provisions of this Act, a person is required to renounce the nationality or citizenship of any country other than Uganda and the law of such other country makes no provision for the renunciation of nationality or citizenship, such person shall make the appropriate declaration specified in the Third Schedule to this Act; and a person who makes such declaration shall be treated as having complied with any such requirement.

(2)Where, under Chapter II of the Constitution, a person is required to make any declaration of his intentions concerning residence, he shall make a declaration in the form specified in the Fourth Schedule to this Act, with such variations as the circumstances of the case require.

20. Evidence.

(1)Every document purporting to be a notice, certificate, order or declaration, or any entry in a register, or a subscription of an oath of allegiance or declaration of renunciation, given, granted or made under the provisions of Chapter II of the Constitution or under this Act, shall be received in evidence, and shall, unless the contrary is proved, be deemed to have been given, granted or made by or on behalf of the person by whom or on whose behalf it purports to have been given, granted or made.

(2)Prima facie evidence of any document of the kind mentioned in subsection (1) of this section may be given by production of a document purporting to be certified as a true copy thereof by such person and in such manner as may be prescribed.

(3)Any entry in a register made under the provisions of Chapter II of the Constitution, or under this Act, shall be received as evidence of the matters stated in the entry.

21. Offences.

(1)Any person who, for the purpose of procuring anything to be done or not to be done under the provisions of Chapter II of the Constitution, or under this Act, makes any statement which he knows to be false in a material particular, or recklessly makes any statement which is false in a material particular, shall be guilty of an offence and shall be liable on conviction to a fine not exceeding two thousand shillings or to imprisonment for a term not exceeding six months or to both such fine and imprisonment.

(2)Any person who fails to comply with any requirement imposed on him by regulations made under this Act with respect to the delivering up of certificates of naturalization or certificates of registration shall be guilty of an offence and shall be liable on conviction to a fine not exceeding two thousand shillings or to imprisonment for a term not exceeding six months or to both such fine and imprisonment.

22. Regulations.

(1)The President may make regulation-

(a)for prescribing any matter which is to be prescribed under this Act, other than a matter for which provision may be made under subsection (2) of this section;

(b)for the registration of anything required or authorized under Chapter II of the Constitution or under this Act to be registered;

(c)for the administration and taking of oaths of allegiance under Chapter II of the Constitution or under this Act; for the time within which oaths of allegiance shall be taken and for the registration of oaths of allegiance;

(d)for the giving of any notice required or authorized to be given to any person under this Act;

(e)for the cancellation of the registration of, and the cancellation and amendment of certificates of naturalization relating to, persons deprived of citizenship under this act, and for requiring such certificates or certificates of registration to be delivered up for those purposes;

(f)for the registration of the births and deaths of persons of any class or description born or dying elsewhere than in Uganda, and otherwise for registration at Uganda consulates;

(g)for enabling the births and deaths of citizens of Uganda born or dying in any country in which the Government of Uganda has for the time being no diplomatic or consular representative to be registered by persons serving in the diplomatic, consular or other foreign service of any country which, by arrangement with the Government of Uganda, has undertaken to represent that Government's interest in that country, or by a person authorized in that behalf by the minister, and for the registration thereby of citizens of Uganda ordinarily resident outside Uganda;

(h)for matters incidental to and connected with the matters mentioned in the preceding paragraphs of this subsection.

(2)The Minister may make regulations-

(a)prescribing forms; and

(b)providing for the imposition and recovery of fees,

in respect of any application made to the Minister or in respect of any registration, or the making of any declaration, or the grant of any certificate, or the taking of any oath of allegiance, authorized to be made, granted or taken under Chapter II of the Constitution or under this Act, and in respect of supplying a certified or other copy of any notice, certificate, order, declaration or entry, given, granted or made under that Chapter of the Constitution or under this Act.

PART V-PROVISIONS PELASTING TO TIME.

23. Provisions relating to section 8 of the Constitution.

(1)The period during which any woman to whom subsection (3) of section 8 of the Constitution applies may register under that subsection shall be the lifetime of the husband to which that subsection refers, and for the purposes of paragraph (b) of subsection (6) of subsection(6) of that section, that period is hereby prescribed.

(2)The Minister, and any officer of the Government authorized in that behalf by the minister, may-

(a)declare that the specified date relating to any person to whom subsection (6) of section 8 of the Constitution refers, who is of unsound mind during any period between the 9th October, 1962, and the date declared by that subsection to be the specified date in relation to that person, shall be such later date as will, in the opinion of the Minister or such authorized officer, permit such person when of sound mind an opportunity of making application for registration under section 8 of the Constitution;

(b)in any other case in which he is satisfied that a person to whom subsection (6) of section 8 of the Constitution refers is, by reason of any circumstances not attributable to his default or neglect, unable to make application within the time prescribed in relation to that person in that subsection or in subsection (1) f this section, declare that the specified date in relation to that person shall be such later date as will permit such person an opportunity of making application for registration under section 8 of the Constitution.

(3)The power of the Minister, and any officer of the Government authorized in that behalf by the Minister, under this section may be exercised before or after the relevant date declared by section 8 of the Constitution to be the specified date.

24. Provisions relating to section 12 of the Constitution.

(1)The specified date in relation to any person to whom subsection (6) of section 12 of the Constitution refers who is of unsound mind during any period commencing-

(a)on the date on which he attains twenty-one years of age; or

(b)on the date on which, having first attained the age of twenty-one years or, in the case of a woman, having first married, he acquires the citizenship of some country other than Uganda otherwise than in the circumstances described in paragraph (a) of subsection (3) of that section,

and ending on the date declared to be the specified date by subsection (6) of that section shall be the first anniversary of the date on which such person ceases to be of unsound mind; and where before the first anniversary of that date, or any later date which may be taken for the purpose under the succeeding provisions of this section, such person again becomes of unsound mind, the specified date shall be the first anniversary of the date on which he subsequently ceases to be of unsound mind.

(2)The minister or any officer of the Government authorized in that behalf by the Minister may, in any case in which he is satisfied that a person to whom subsection (6) of section 12 of the Constitution refers is, by reason of any circumstances not attributable to such person's default or neglect, unable to renounce his citizenship of some country other than Uganda or take the oath of allegiance, or make or register any such declaration as is specified in the Fourth Schedule to this Act within the time prescribed in relation to that person in that subsection, or any later date declared under this subsection, declare that the specified date in relation to that person shall be such later date as will permit that person an opportunity of doing all such acts, or all such acts as remain to be done:

provided that nothing in this subsection shall confer on the minister or any such authorized officer power to make any such declaration in relation to any such person after he has ceased to be a citizen of Uganda.

FIRST SCHEDULE. OATH OF ALLEGIANCE.

I,………………., swear that I will be faithful and bear true allegiance to the Sovereign State of Uganda and that I will support and uphold the Constitution of Uganda as by law established.

So help me God.

SECOND SCHEDULE. QUALIFICATIONS FOR NATURALIZATION.

1.Subject to the provisions of the next following paragraph 2 of this Schedule, the qualifications for naturalization of an alien who applies therefor are-

(a)that he has resided in Uganda throughout the period of twelve months immediately preceding the date of the application; and

(b)that during the seven years immediately preceding that said period of twelve months he has resided in Uganda for periods amounting in the aggregate to not less than five years; and

(c)that he has an adequate knowledge of a prescribed vernacular language or of the English language; and

(d)that he is of good character; and

(e)that he would be a suitable citizen of Uganda; and

(f)that he intends, if naturalized, to continue to reside permanently in Uganda.

2.The Minister, if in the special circumstances of any particular case he thinks fit, may-

(a)allow a continuous period of twelve months ending not more than six months before the date of application to be reckoned for the purposes of sub-paragraph (a) of paragraph 1 of this Schedule as though it had immediately preceded that date;

(b)allow periods of residence earlier than eight years before the date of application to be reckoned in computing the aggregate mentioned in sub-paragraph (b) of paragraph 1 of this Schedule.

THIRD SCHEDULE. DECLARATION CONCERNING CITIZENSHIP. (Under section 12 of the Constitution).

I,………………………………(full name in block capitals) do solemnly and sincerely declare:-

1.That I was born at……………………..in ó Uganda/……………………(insert name of country) and am of or over the age of twenty-one years.

2.That I am a citizen of Uganda by óbirth/descent/registration/naturalization and am also a national of…………………….(insert name of country) by óbirth/descent/registration/naturalization/marriage.

3.That as I am desirous of retaining my status as a citizen of Uganda, I hereby renounce so far as it lies within my power my status as a citizen/national of………………………..(insert name of country) and any claim I have to the protection of that country.

……………………………

Signature of Applicant.

DECLARED at …………………………….., this…………………..day of……………….,19……………., before me.

………………………………..

óMagistrate/Commissioner for Oaths.

óDelete as applicable.

OR

(Under sections 3, 4 and 7 of the Act).

I,……………………….,(full name in block capitals) do solemnly and sincerely declare:-

1.That I was born at …………………………(insert name of country) and am of or over the age of twenty-one years.

2.That I have been granted Uganda citizenship by óregistration/naturalization on condition that I renounce my citizenship/nationality of ……………………..(insert name of country).

3.I hereby renounce so far as it lies within my power my status as a citizen/national of……………………………(insert name of country) and any claim I have to the protection of that country.

………………………………….

Signature of Applicant.

DECLARED at …………………this ……………………………..day of………………………..19………………, before me.

………………………………..

óMagistrate/Commissioner for Oaths.

óDelete as applicable.

FOURTH SCHEDULE-DECLARATION CONCERNING RESIDENCE. (under section 12 of the Constitution).

I,………………….,of……………………………do solemnly and sincerely declare:-

ó1.That so far as it lies within my power, I have renounced my citizenship/nationality of ……………………………..(insert name of country) and intend to reside permanently in Uganda if permitted.

ó2.That although I have renounced my citizenship/nationality of ………………………(insert name of country) and intend my domicile of choice to be Uganda it may be necessary in the course of my employment as…………………./self-employed to be absent from time to time from Uganda.

…………………………

Signature of applicant.

DECLARED at …………………….this ………………………….day of…………………………….,19………., before me.

…………………………………

Magistrate/Commissioner for Oaths.

Delete paragraphs or words not applicable.

 

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