FORM 3
Reg. 11 (3)
THE REPUBLIC OF UGANDA
1. I ............................................................... (Please state name and address)
apply to use my own equipment to make a copy of the following records:(a ) ................................................................................................................................
(b ) ...........................................................................................................................
(c ) ................................................................................................................................
(d ) .........................................................................................
(e ) ................................................................................................................................

2. Reasons for using own equipment
(f ) ..........................................................................................

(g)..............................................................................................................................

00 ............................................................................................

(0 ...................................................................
(j) ..............................................................................................................................
Date: ........................................................... 20 ............................

Signature of Requester 148

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