Surname: JALIA

Other names: NYOMBI

Sex: FEMALE

Class: BABY CLASS

Date of birth: 11/11/2015

Telephone No: 0708 519 029

Residential address: SALAMA

RECOMMENDER: I certify that the applicant is personally known to me and to the best my knowledge and belief, facts stated on this form are correct. I am a citizen of Uganda.

Full names: NASIMBWA JANE

Address: SALAMA                                                                   signature …………………….

BASIC AIDS ORGANISATION:

We as the organization we agreed with this information obtained here for any assistance rendered

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THANK YOU MAY GOD BLESS YOU