I, _________________________ of _____________________ holding the post of ____________________ at the Solid Waste Management Authority (the Authority) hereby certify that the sum of ______________ is owed to the Authority with respect to ___________ as set out in the attached Statement of Claim.
I further certify that the above-mentioned sum is owed to the Authority for a period of more than 30 days. |
| Sworn to at | this | day of | , 20 |
| BEFORE ME: | ____________________________________
Registrar of the Supreme Court |
| ___________________________________________________ |
| FILED in the | Land Registry/Registry of Deeds and Mortgages |
| this | day of | , 20 |
| __________________________________
Registrar of Lands/Registrar of Deeds and Mortgages |
| STATEMENT OF CLAIM |