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STATUTORY DECLARATION

I .............................................................................................................................. of ............................................................................................................................ in the State of ......................................................................................................... do solemnly and sincerely declare as follows: ................................................................................................................................ ................................................................................................................................ ................................................................................................................................ ................................................................................................................................ ................................................................................................................................ ................................................................................................................................ ................................................................................................................................ ................................................................................................................................ ................................................................................................................................ ................................................................................................................................ And I make this solemn Declaration conscientiously believing the same to be true and under and by virtue of the provisions of the Oaths Act, 1900. Declared at....................................} ......................................................} this ...............................................} .................................................................... ......................................................} (Signature) day of ...................................20....} ........................................................ Justice of the Peace

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Statutory Declaration

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