State of Victoria Evidence Act 1958

STATUTORY DECLARATION TEMPLATE

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State of Victoria – Evidence Act 1958 STATUTORY DECLARATION

I, [INSERT FULL TIME] Of [INSERT ADDRESS AND OCCUPATION], do solemnly and sincerely declare that [INSERT MATTERS TO BE DECLARED]

I acknowledge that this declaration is true and correct, and I make it with the understanding and belief that a person who makes a false declaration is liable to the penalties of perjury.

Declared at ______in the State of Victoria, this ______day of

______20 ____ ...... Signature of person making this declaration

[to be signed in front of an authorised witness]

Before me,

...... Signature of authorised witness

The authorised witness must print or stamp his or her name, address, and title under section 107A of the Evidence Act 1958 [Vic.] (eg. Justice of the Peace, Pharmacist, Police Officer, Court Registrar, Bank Manager, Medical Practitioner, Dentist)