s /5 Signature: Name: DISTRIBUTION: ATTACH TO REPORT DOCUMENTATION Rev:sed 1/07/2013 Page 1 a I Government of South Australia EFTA00265381 SOrsif1/41 Nei> PeKMANAM I Nat) NIE5 MRF-ST Fok -TEST- SOUTH AUSTRALIA AFFIDAVIT I, Vg,Lcr-4.3( SA‘piachiS • make oath and say; L. te 1.4 E v6.4.4c. Ø r3