I, Raja Masood Nawaz Khan, a Canadian Senior Citizen, holding OHIP Card # 4016-646-129-KJ, residing at: 6122-A Douguy Blvd. Mississauga, ON L5V 1B3, do hereby state on Solemn affirmation as under: To have an Eye Specialist appointment, I was advised by my family doctor to see any Optometrist, hence on October 1, 2020, I visited Derry Village Optical Store to see the Optometrist doctor Atif Paravaiz and it was my very first visit to their Store. The same day in the afternoon, the said Optometrist Atif examined my eyes and during my eye examination, I told the Optometrist that previously, I have been visiting Prism Eye Institute multiple times and they have my eyes treatment record, hence please refer me to any Eye Specialist at Prism Eye Institute and the Optometrist doctor Atif agreed for that. After the completion of my eye’s examination, I asked doctor Atif to have my Eyes Examination Medical Report and he told me that this report will be send to my family d0ctor For my