Telecommunications Request Page 3
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I hereby certify that before administering the *oath / taking the affirmation I asked
the Deponent the following questions and noted *her/his answers in *her/his
presence as indicated below:-
(a) Do you know and understand the contents of the above declaration?
Answer ______________________________________________________.
(b) Do you have any objection to taking the prescribed oath?
Answer ______________________________________________________.
(c) Do you consider the prescribed oath to be binding on your conscience?
Answer _______________________________________________________.
I hereby certify that the Deponent has acknowledged that *she/he knows and
understands the contents of this declaration which was *sworn to / affirmed before
me, and the Deponent’s *signature / thumb print / mark was placed thereon in my
presence.
Dated at _____________________ this ____ day of ______________ year ____.
______________________________________
Justice of the Peace / Commissioner of Oaths
Full Names______________________________________________________
Designation______________________________________________________
Area for which appointed____________________________________________
Work Address
________________________________________________
________________________________________________
________________________________________________
__________________________________________________________________
*Delete whichever is not applicable
Department of Justice and Constitutional Development
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