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STATUTORY DECLARATION

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 .. Name of authorised witness and qualification as such witness Form 99 IMPORTANT This DECLARATION must be made before any of the following persons: Academic (post-secondary institution), accountant, architect, Australian consular officer, Australian diplomatic officer, bailiff, bank manger.

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

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