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GUARDIANS FUND AFFIDAVIT FORM To be submitted with first application and / or when an increase of allowance is requested A. I full names of Applicant declare under oath the following B. PARTICULARS OF APPLICANT Full names Surname ID number Residential address Postal address Tel number Work Tel number Home Cell number Occupation of Applicant Relationship to Minor C. Full names and Surname Birth date Age of minor D. Gender of minor THE MINOR S HAS / HAVE THE FOLLOWING ASSETS E* THE MINOR S RECEIVES / RECEIVE THE FOLLOWING INCOME R PER MONTH FROM F* G* ALLOWANCES OR ANY INCOME THAT ARE BEING PAID TO THE APPLICANT BY OTHER INSTANCES ARE AS FOLLOW Source / from whom received Amount Period received H. ANY INFORMATION WHICH I CONSIDER ESSENTIAL IS / ARE AS FOLLOW I. THIS SECTION NEEDS ONLY TO BE COMPLETED BY APPLICANT IF APPLICANT IS THE BIOLOGICAL OR ADOPTED PARENTS OF THE MINOR Description and value of all assets or possessions of Applicant A complete list of liabilities on the said assets Monthly income of the Applicant e*g* Salary pension etc* Monthly expenditure of the Applicant duly specified DATE SIGNATURE OF APPLICANT PRINT NAME AND SURNAME I certify that the deponent has acknowledge that he / she knows and understands the contents of this affidavit / declaration COMMISSIONER OF OATHS OFFICE HELD Stamp FULL NAMES ADDRESS. I full names of Applicant declare under oath the following B. PARTICULARS OF APPLICANT Full names Surname ID number Residential address Postal address Tel number Work Tel number Home Cell number Occupation of Applicant Relationship to Minor C. Full names and Surname Birth date Age of minor D. Gender of minor THE MINOR S HAS / HAVE THE FOLLOWING ASSETS E* THE MINOR S RECEIVES / RECEIVE THE FOLLOWING INCOME R PER MONTH FROM F* G* ALLOWANCES OR ANY INCOME THAT ARE BEING PAID TO THE APPLICANT BY OTHER INSTANCES ARE AS FOLLOW Source / from whom received Amount Period received H. Full names and Surname Birth date Age of minor D. Gender of minor THE MINOR S HAS / HAVE THE FOLLOWING ASSETS E* THE MINOR S RECEIVES / RECEIVE THE FOLLOWING INCOME R PER MONTH FROM F* G* ALLOWANCES OR ANY INCOME THAT ARE BEING PAID TO THE APPLICANT BY OTHER INSTANCES ARE AS FOLLOW Source / from whom received Amount Period received H. ANY INFORMATION WHICH I CONSIDER ESSENTIAL IS / ARE AS FOLLOW I. THIS SECTION NEEDS ONLY TO BE COMPLETED BY APPLICANT IF APPLICANT IS THE BIOLOGICAL OR ADOPTED PARENTS OF THE MINOR Description and value of all assets or possessions of Applicant A complete list of liabilities on the said assets Monthly income of the Applicant e*g* Salary pension etc* Monthly expenditure of the Applicant duly specified DATE SIGNATURE OF APPLICANT PRINT NAME AND SURNAME I certify that the deponent has acknowledge that he / she knows and understands the contents of this affidavit / declaration COMMISSIONER OF OATHS OFFICE HELD Stamp FULL NAMES ADDRESS. I full names of Applicant declare under oath the following B. PARTICULARS OF APPLICANT Full names Surname ID number Residential address Postal address Tel number Work Tel number Home Cell number Occupation of Applicant Relationship to Minor C. Full names and Surname Birth date Age of minor D. Gender of minor THE MINOR S HAS / HAVE THE FOLLOWING ASSETS E* THE MINOR S RECEIVES / RECEIVE THE FOLLOWING INCOME R PER MONTH FROM F* G* ALLOWANCES OR ANY INCOME THAT ARE BEING PAID TO THE APPLICANT BY OTHER INSTANCES ARE AS FOLLOW Source / from whom received Amount Period received H. ANY INFORMATION WHICH I CONSIDER ESSENTIAL IS / ARE AS FOLLOW I. THIS SECTION NEEDS ONLY TO BE COMPLETED BY APPLICANT IF APPLICANT IS THE BIOLOGICAL OR ADOPTED PARENTS OF THE MINOR Description and value of all assets or possessions of Applicant A complete list of liabilities on the said assets Monthly income of the Applicant e*g* Salary pension etc* Monthly expenditure of the Applicant duly specified DATE SIGNATURE OF APPLICANT PRINT NAME AND SURNAME I certify that the deponent has acknowledge that he / she knows and understands the contents of this affidavit / declaration COMMISSIONER OF OATHS OFFICE HELD Stamp FULL NAMES ADDRESS.

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