STATUTORY DECLARATION

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Form 99 WESTERN australia _________________________ Oaths, Affidavits and STATUTORY Declarations Act 2005 STATUTORY DECLARATION _________________________ (1) Christian name or names and surname of declarant in full. I (1) (2) Address. (2) (3) Occupation. in the state of Western australia (3) sincerely declare as follows: 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 this ................day of ..................................... (4) (4) Ordinary signature of declarant. by ........................................ ........................................ in the presence of.

Form 99 WESTERN AUSTRALIA _____ Oaths, Affidavits and Statutory Declarations Act 2005 STATUTORY DECLARATION _____ (1) Christian name or

  Declaration, Statutory, Australia, Statutory declaration