This legislation has been repealed.
(Clause 8)
I, (full name):
of (residential address):
solemnly and sincerely declare that:
• my date of birth is:
• *I am employed by (employer's name):
or
*I am self-employed as (present position):
• I hold the following trade, academic or professional qualifications:
• I am a member of the following organisations:
• I hold the following offices (other than employment):
• the following information is relevant to my candidature (not more than 4 type-written lines):
I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Oaths Act 1900 .
• declared at (place of signing):
• on this date (date of signing):
• before me (signature of Justice of the Peace):
(* Delete whichever does not apply)