Surname: MIREMBE
Other names: ESTHER
Sex; FEMALE
Class: BABY CLASS
Date of birth: 22/ 12/ 2016
Telephone No; 0784319101
Residential address: MASSAJJA
RECOMMENDER: I certify that the applicant is personally known to me and to the best of my knowledge and belief, facts stated on this form are correct. I am a citizen of Uganda.
Full names: CHADIGA RICHARD
Address MASSAJJA signature ……………………………..
BASIC AIDS ORGANISATION
We as the organization we agreed with this information obtained here for any assistance rendered
………………………………………………………………………….
………………………………………………………………………….
THANK YOU MAY GOD BLESS YOU