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.

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

  Declaration, Statutory, Statutory declaration