Surname: NABBALE

Other names: SHAKIRA

Sex: FEMALE

Class:  S.1

Date of birth: 17/ 01/ 2004

Telephone No: 0779 45 75 81

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; NABBALAE SHAKIRA

Address: SALAAMA                                                                  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