Statutory Declaration - Western Australia

WESTERN
AUSTRALIA
WESTERN AUSTRALIA
O
O
A
A
T
T
H
H
S
S
,
,
A
A
F
F
F
F
I
I
D
D
A
A
V
V
I
I
T
T
S
S
A
A
N
N
D
D
S
S
T
T
A
A
T
T
U
U
T
T
O
O
R
R
Y
Y
D
D
E
E
C
C
L
L
A
A
R
R
A
A
T
T
I
I
O
O
N
N
S
S
A
A
C
C
T
T
2
2
0
0
0
0
5
5
S
S
T
T
A
A
T
T
U
U
T
T
O
O
R
R
Y
Y
D
D
E
E
C
C
L
L
A
A
R
R
A
A
T
T
I
I
O
O
N
N
I, .........................................................................................................................................
............................................................................................................................................
{name, address and occupation of person making declaration}
sincerely declare as follows:-
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
{insert content of the statutory declaration; use numbered paragraphs if content is long}
This declaration is true and I know that it is an offence to make a declaration knowing that
it is false in a material particular.
This declaration is made under the Oaths, Affidavits and Statutory Declarations Act 2005
at .....................................................................
{place}
........................................................................
{date}
in the presence of -
........................................................................
{Signature of authorised witness}
........................................................................
........................................................................
{Name of authorised witness and qualification as such a
witness}
by...............................................
{Signature of person making the
declaration}
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