ice Officer 0 Justice of the Peace (Signatu of person before whom affidavit *sworn /affirmed and declared) 0 Other (Specify) Before me: poiRT FfRig PE:ragiov (Name) 30130 (to / Signing V) Pfel (Station / Suburb) Revised: 24/11/2015 EFTA00262262 EFTA00262263 EFTA00262264 EFTA00262265