Schedule 3—Form of statutory declaration
I, [ name, address and occupation of person making the statutory declaration ], make the following statutory declaration under the Oaths and Affirmations Act 2018 :
[ insert statement to be declared using numbered paragraphs ]
1.
I declare that the contents of this statutory declaration are true and correct and I make it knowing that making a statutory declaration that I know to be untrue is an offence.
[ signature of person making this statutory declaration in the presence of the authorised statutory declaration witness ]
Declared at [ place ] in the State of Victoria
on [ date ]
I am an authorised statutory declaration witness and I sign this document in the presence of the person making the declaration:
[ signature of authorised statutory declaration witness ]
on [ date ]
[ full name and personal or professional address of authorised statutory declaration witness in legible writing, typing or stamp ]
[ qualification as an authorised statutory declaration witness ]
A person authorised under section 30(2) of the Oaths and Affirmations Act 2018 to witness the signing of a statutory declaration.
*I confirm that reasonable modifications were used in preparing this statutory declaration and that the contents of this statutory declaration were read to the person making the statutory declaration in a way that was appropriate to the person's circumstances.
[ signature of authorised statutory declaration witness ]
*delete if not applicable