In the matter of

MATTER

STATUTORY DECLARATION

 

I, NAME, holder of ID, of ADDRESS,  solemnly and sincerely declare that: :

STATEMENT

           I understand that any person who knowingly and wilfully makes a statement false in a material particular, such statement being made in a statutory declaration, shall be guilty of an offence and shall be liable on conviction upon indictment to imprisonment and to a fine. 

 

And I make this solemn declaration conscientiously believing the same to be true and by virtue of the laws of JURISDICTION_STATE.

 

 

Signed: .......................................
NAME

Declared at [insert address] in JURISDICTION_STATE this 27 December 2024.

Before me,

[Signature and designation, i.e., Justice of the Peace/Notary Public/Commissioner for Oaths.]

In the matter of 

MATTER

 

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