I, of (state capacity of deponent) make oath and say that the return of unclaimed moneys in the hands of subscribed by me is to the best of my knowledge and belief a true and complete return as required by the said Act, and that during the year ending the thirty-first day of December now last past no unclaimed moneys have been transferred by or on behalf of the said out of Zimbabwe or placed to any suspense or other account with a view to evading the provisions of this Act, and that all amounts which ought to be included in the said return are duly included therein. Sworn at this day of , 19 . Justice of the Peace.