Undertaking

I _________ son/daughter/wife of _________ resident of _________ do hereby solemnly affirm and state as hereunder:

I was last employed with _________  at address _________ From _________, _________ to _________, _________ and _________, I am holding the position of _________ I _________.

I hereby declare that I _________.

I further declare and affirm that I shall _________.

Name: _________    Employee No.: _________

Date: _________    Signature: _________

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