AFFIDAVIT BY ELECTRONIC COMMUNICATIONS SERVICE

PROVIDER TO FURNISH ADDITIONAL EVIDENCE TO COURT

SECTION 4(4)(b) OF THE PROTECTION FROM HARASSMENT ACT, 2011 (ACT NO. 17 OF 2011)

(CONFIDENTIAL)

APPLICATION NO ............/20.......

DIRECTION NO ............./20......

To: ............................................................................................................................................. (name and surname of clerk of the court identified in the direction)

Facsimile number: ......................................................................

From: .........................................................................................................................................(name and surname of designated person) of ....................................................................................................................................................(name of electronic communications service provider)

E-mail address:...............................................................................................................................................................

Facsimile number:..........................................................................................................................................................

Telephone number:........................................................................................................................................................

AFFIDAVIT NO: ............................................../20.......

I, .................................................................................................................................................................................................................... (name, surname and identity number) working as a.....................................................................................................................................................................................(designation) at............................................................................................................................................................................................ (name of electronic communications service provider) situated at the following address............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................., hereby states as follows in response to the request for further evidence:.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

I certify that before administering the *oath / taking the affirmation I asked the Deponent the following questions and noted *her/his answers in *her/his presence as indicated below:-

(a) Do you know and understand the contents of the above declaration?

Answer________________________________________________________________

(b) Do you have any objection to taking the prescribed oath?

Answer________________________________________________________________

(c) Do you consider the prescribed oath to be binding on your conscience?

Answer________________________________________________________________

I certify that the Deponent has acknowledged that *she/he knows and understands the contents of this declaration which was *sworn to / affirmed before me, and the Deponent's signature was placed thereon in my presence.

Dated at __________________________________________________this ________________________day of___________________________________________ 20___________

_____________________________________________

Justice of the Peace / Commissioner of Oaths

Full Names:_________________________________________________________________________________________________________________________________________________

Designation:________________________________________________________________________________________________________________________________________________

Area for which appointed:____________________________________________________________________________________________________________________________________

Business Address:___________________________________________________________________________________________________________________________________________

(CONFIDENTIAL)

***********************************