Statutory Declaration Australia

State of Victoria

Statutory Declaration

[full name]

[address]

, do solemnly and sincerely declare that:-

[occupation]

I acknowledge that this declaration is true and correct, and I make it with the understanding and

belief that a person who makes a false declaration is liable to the penalties of perjury.

Declared at

……………………………………...

this

day of

Signature of person making this declaration

[to be signed in front of an authorised witness]

Before me,

………………………………………………

Signature of Authorised Witness

The authorised witness must print or stamp his or her name, address and title under section 107A of the Evidence

(Miscellaneous Provisions) Act 1958 (as of 1 January 2010), (previously Evidence Act 1958), (eg. Justice of the Peace,

Pharmacist, Police Officer, Court Registrar, Bank Manager, Medical Practitioner, Dentist)

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Parent category: Financial