[Translator’s notes appear in square brackets]

[Personal information has been redacted.]


I------, surname------, son/daughter of-------, grade-----, class-----, [Baha’i] registration number----- from the city of -----, ID card number------, issued from------, member of the unrecognised Baha’i sect, pledge that I have never taken any action towards the teaching, consolidation, or propagation of this sect and its affiliated institutions.  Furthermore, In the future, I will never venture to participate in any such activities, which are in conflict with the Islamic Republic of Iran.  In the event of my acting contrary to the undertaking given in this present document, the government of the Islamic Republic is free to make any ruling against me, whether it be the discontinuation of my salary and benefits, the reclamation of my salaries and ------.  I divest myself of all rights to any form of appeal in this matter.


Address: City ----- Avenue ----- Street ------ Number ----- Telephone, mine or one of my relatives -----