Affidavit Statutory Declaration

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

AFFIDAVIT / STATUTORY DECLARATION

I, the undersigned, {{declarant_full_name}} (Identity Number: {{declarant_id_number}}),

residing at {{declarant_physical_address}}, do hereby make oath/affirm and state that:

DECLARATION OF TRUTH

1. I am an adult male/female of sound mind and competent to make this affidavit/declaration.

2. The facts contained in this affidavit/declaration are, to the best of my knowledge and belief, both true and correct.

STATEMENT OF FACTS

3. I declare that {{statement_of_facts}}. This occurred on or about {{date_of_incident}} at approximately {{time_of_incident}} at {{location_of_incident}}.

4. I further declare that {{additional_relevant_information}}.

5. I understand the importance of making such a declaration and the legal consequences of making a false statement.

6. I make this declaration solemnly and conscientiously believing the same to be true.

PURPOSE OF DECLARATION

7. This affidavit/declaration is made for the purpose of {{purpose_of_declaration}}, to be submitted to {{recipient_entity}}.

OATH / AFFIRMATION

I declare that I know and understand the contents of this declaration.

I consider the prescribed oath/affirmation to be binding on my conscience.

Thus signed and sworn/affirmed before me at {{place_of_signing}} on this {{day_of_signing}} day of {{month_of_signing}}, {{year_of_signing}} by the Deponent who has acknowledged that he/she knows and understands the contents of this declaration.

And the Deponent acknowledged that he/she considers the prescribed oath/affirmation to be binding on his/her conscience.

Signature Block

_____________________________

Deponent: {{declarant_full_name}}

_____________________________

Commissioner of Oaths/Justice of the Peace

Full Name: {{commissioner_full_name}}

Designation: {{commissioner_designation}}

Address: {{commissioner_address}}

Date: {{date}}