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I, the undersigned, have an interest in the entities below, either directly or indirectly via a related person.
Name of Entity
Company, close corporation, trust, sole proprietor etc. with registration number and nationality of company
Nature of Interest
Shareholder, director, office bearer, member, employee, trustee, beneficiary, consultant, retainer etc. With % interest where applicable.
Self or via a Related Person
If via a related person, please indicate the relationship to you
I declare that: