Surname: NAKALYAGO

Other names: JEMIMAH

Sex: FEMALE

Class: BABY

Date of birth; 6/6/ 2015

Telephone No: 0755 444 054

Residential address: SALAMA

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:  NAMUTEBI AISHA

Address: SALAMA ROAD                                                                   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