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

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THANK YOU MAY GOD BLESS YOU