THIRD SCHEDULE (s.

14 (4))
DECLARATION OF ASSETS, LIABILITIES AND BUSINESS INTERESTS
ANNUAL DECLARATION FORM
1. PERSONAL PARTICULARS

(a) Surname: ...........CHIMALIRO..........................................................

.........

(b)Other Names: ......KHURWA

DESIRE........................................................

(c) Date of
Birth: ...........22/09/1983.................................................................
.

(d)Place of Work: ..........MACOHA NKHOTAKOTA

CBR..........................

(e) PresentGrade/Position: ......ACCOUNTS

ASSISTANT...................................

(f) Date of Appointment/Election: .........1 ST JULY

2009........................................

2. PERIOD OF DECLARATION: ……
2019/2020…………………………………………………
3. Describe any additional assets acquired or sold over the stated period:

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4. Describe any additional liabilities incurred over the stated period:

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5. Describe any additional business interests acquired over the stated period:

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5
6. Any other material information:

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DECLARATION

(a)I declare that the information I have provided above is a correct account of
my situation with regard to assets, liabilities and business interest that could be
attributed to my name;

(b)I have no objection to the Director verifying the above information;

(c)I make this solemn declaration conscientiously believing the same to be true
and by virtue of the Oaths, Affirmations and Declaration Act.

Declared at……NKHOTAKOTA………………………….……........
this........4TH DAY OF OCTOBER 2019......................................................
Signature of the Public Officer …………………………………..
Before me: ........................................................... Commissioner for Oaths

FOR THE DIRECTOR’S USE ONLY

Received
by: ....................................................................................................................
Signature: ..............................................................................................................
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Title: .......................................................................................................................
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Date: ....................................................................................................................