DECLARATION

I, ............................................................................................................, hereby declare the following:

This statement consists of pages, each signed by me. The content of this declaration is true to the best of my knowledge and belief. I am aware that should it be submitted as evidence and I know that something appears therein that I know to be false or believe not to be true, I may be liable to prosecution.

I undertake that, as long as I continue to be a director or executive officer of the institution, I will notify the Registrar of any material changes to, or affecting the completeness or accuracy of, the information supplied by me in items 1 to 40 as soon as possible, but in no event later than 21 days from the day that the changes come to my attention.

Taking into account the commitments set out in question 40, I confirm that I have sufficient time available to duly discharge my duties and responsibilities as a director of this  institution.*

I know and understand the content of this declaration. I have*/do not have* objections to taking the prescribed oath*/ affirmation*.

I consider the prescribed oath*/ affirmation* to be binding*/not binding* on my conscience.

........................................................................................................................   SIGNATURE OF DEPONENT

I certify that the above statement was taken by me and that the deponent has acknowledged that he /she knows and understands the content of this statement. This statement was sworn to*/affirmed before me and the deponent's signature was placed thereon in my presence at ........................................................on this.............................. day of .................................(yyyy-mm).

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COMMISSIONER OF OATHS

FULL NAMES:        .......................................................................................................................

EX OFFICIO:        .......................................................................................................................

AREA:                .......................................................................................................................

ADDRESS:        .......................................................................................................................

* Delete whichever is not applicable

Note: Each page of the form BA 020, and each additional page attached thereto, shall be initialled by the relevant signatories, that is, the relevant applicant, commissioner of oaths, and the chairperson of the board of directors or external auditor.