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Get Mervin Watty

In receipts without deduction of tax I, *son/daughter/wife of resident of do hereby declare1. *that the shares/securities/sums, particulars of which are given in the Schedule below, stand in my name and are beneficially owned by me, and the dividend/interest in respect of such *securities/sums and/or income in respect of units is/are not includible in the total.

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