THE NORTHERN TERRITORY OF AUSTRALIA

OATHS ACT
STATUTORY DECLARATION
_________________
(1) Insert name and I, (1)
address of person
making declaration do solemnly and sincerely declare (2)

(2) Here insert the

matter declared to
either directly
following the word
“declare”or, if the
matter is lengthy,
insert the words äs
follows”and
thereafter set out
the matter in
numbered
paragraphs

And I make this solemn declaration by virtue of the Oaths Act and conscientiously believing the
statements contained in this declaration to be true in every particular.

Declared at the day of 20

(3) Signature of the (3)
person making the
declaration ................................................................................................
(4) Signature of the (4)
person before
whom the ................................................................................................
declaration is made
(5) Here insert Before me, (5)
name and contact ................................................................................................
address or
telephone number
of person before
whom the
declaration is made,
legibly written,
typed or stamped

(6) THIS DECLARATION MAY BE MADE BEFORE ANY PERSON WHO HAS ATTAINED
THE AGE OF (18) EIGHTEEN YEARS.

NOTE: A person wilfully making a false statement in a statutory declaration is liable to a penalty of
$2000 or imprisonment of 12 months, or both.