Awarded to First Name *     Last Name *  for long and approved service of number *  years with name of employer *   on/at  name of company/farm name and area *    

In respect of the applicant, First Name *     Last Name *  , I hereby declare that to the best of my knowledge the information provided is a true statement, and I support the application for the Medal and Certificate awarded by RHASS.

In respect of the applicant,   First Name *     Last Name *  , I hereby declare that he/she is personally known to me; to the best of my knowledge the information on this form is a true statement of his/her service; and that I consider him/her in every respect a suitable person to receive the Medal and Certificate awarded by RHASS.