Victorian Consolidated Regulations

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OATHS AND AFFIRMATIONS (AFFIDAVITS, STATUTORY DECLARATIONS AND CERTIFICATIONS) REGULATIONS 2018 - SCHEDULE 3

Schedule 3—Form of statutory declaration

Regulation 9(1)

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



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