AFFIDAVIT - STATUTORY DECLARATION

I, [SPECIFY NAME], of the City of [CITY] the [State/Province] of [STATE/PROVINCE], do solemnly declare as follow:

1. I am one of the applicants herein.

2. I have knowledge of the matter, and that the statements in the annexed application contained are, to the best of my knowledge and belief, true in substance and in fact.

3. I am informed and believe that each applicant signing the said application is of the full age of [SPECIFY AGE] years and has power under law to contract and that his or her name and description have been accurately set out in the preamble thereto.

4. The proposed corporate name of the company is not on any public grounds objectionable and that it is not that of any known company, incorporated or unincorporated, or of any partnership or individual, or any name under which any known business is being carried on, or so nearly resembling the same as to deceive.

5. I have satisfied myself and am assured that no public or private interest will be prejudicially affected by the incorporation of the company aforesaid.

AND I HAVE SIGNED

[SPECIFY NAME]:

DECLARED BEFORE me at [SPECIFY],

in the Regional Municipality of [SPECIFY],

this [DAY] day of [MONTH, YEAR]