Hi, thanks for your question. My name's XXXXX XXXXX I'm going to assist you with it.
There is no publicly available "form" for this particular kind of affadavit. A template can be found in the legal practitioner's text (Tristram and Cootes) and a solicitor will be able to prepare it for you. It must also be sworn in front of a commissioner for oaths (which includes a solicitor), so it may be best to make an appointment with your solicitor to have this prepared, sworn and submitted
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