Date | Venue / Stadium | Time | Attendance |
| 11 November 2011 | Roche Caiman / Stade Linite | 17:00 | 2000 |
Referee Denis BATTE (UGA) | Assistant Referee 1 Mark SSONKO (UGA) |
Fourth Official Ali KALYANGO (UGA) | Assistant Referee 2 Balikoowa NGOBI (UGA) |
| a.e.t.: | After extra time | (C): | Captain | PSO: | Penalty Shoot-out |
| GK: | Goalkeeper | N: | Not eligible to play | I: | Injured |
| Y: | Misses next match if booked | Pos: | Positions | A: | Absent |