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STATUTORY DECLARATION - Landgate

FORM B3 WESTERN AUSTRALIA TRANSFER OF LAND ACT 1893 OATHS, AFFIDAVITS AND STATUTORY DECLARATIONS ACT 2005 STATUTORY DECLARATIONI / WE (name, address and occupation of person(s) making the DECLARATION ) sincerely declare as follows - This DECLARATION is true and I / WE 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 at (place) _____ on _____ day of _____ 20 _____ by - _____ Signature of person(s) making the DECLARATION (sign in the space above) In the presence of - _____ Signature of authorised witness (sign in the space above) (Print the full name, address and qualification of authorised witness in the space above) INSTRUCTIONS 1.

A member of the National Insurance Brokers Association of Australia (ACN 006 093 849). Insurance broker . 19. A Justice of the Peace. Justice of the Peace ... A member of the Australasian Institute of Chartered Loss Adjusters (ACN 074 804 167). Loss adjuster : 24. An authorised celebrant within the meaning of the . Marriage Act 1961.

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