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4. THAT the matter was reported at the Police Station where an abstract was issued.
5. THAT I therefore Request the Immigration Officer to issue me with another passport.
PERIS MUMBI }
This…………day of………, 2016 }
}
} ________________
} DEPONENT
}
}
BEFORE ME
COMMISIONER OF OATHS
DRAWN BY:
RAUTTA & COMPANY ADVOCATES
SONALUX HOUSE 3RD FLOOR,
NAIROBI