diagnostic test results, knowledge of regional practices of torture, consultation reports, etc.) and allegations of torture and ill-treatment. 2. Reiterate the symptoms and disabilities from which the individual continues to suffer as a result of the alleged abuse. 3. Provide any recommendations for further evaluation and care for the individual. XIV. Statement of truthfulness (for judicial testimony) For example: “I declare under penalty of perjury, pursuant to the laws of .......................... (country), that the foregoing is true and correct and that this affidavit was executed on ........................(date) at ..........................(city), .................................... (State or province).” XV. Statement of restrictions on the medical evaluation/investigation (for subjects in custody) For example: “The undersigned clinicians personally certify that they were allowed to work freely and independently and permitted to speak with and examine (the subject) in private, without any restriction or reservation, and without any form of coercion being used by the detaining authorities”; or “The undersigned clinician(s) had to carry out his/her/their evaluation with the following restrictions: ..........................” XVI. Clinician’s signature, date, place XVII. Relevant annexes A copy of the clinician’s curriculum vitae, anatomical drawings for identification of torture and ill-treatment, photographs, consultations and diagnostic test results, among others. 30