Commonwealth Consolidated Regulations

STATUTORY DECLARATIONS REGULATIONS 1993 - SCHEDULE 1

(regulation 3)

STATUTORY DECLARATION

Statutory Declarations Act 1959

I, [ Name, address and occupation of person making the declaration make the following declaration under the Statutory Declarations Act 1959 :

1.         Set out matter declared to in numbered paragraphs

2.

3.

I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959 , and I believe that the statements in this declaration are true in every particular.

Signature of person making the declaration

Declared at   place   on   day   of  month   year

Before me,

Signature of person before whom the declaration is made

Full name, qualification and address of person before whom the declaration is made (in printed letters)

Note 1    A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment for a term of 4 years — see section 11 of the Statutory Declarations Act 1959 .

Note 2    Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959  — see section 5A of the Statutory Declarations Act 1959 .