Commonwealth of Australia

STATUTORY DECLARATION
Statutory Declarations Act 1959
1 Insert the
name,
address and
occupation of
person making
the declaration
I,
1
make the following declaration under the Statutory Declarations Act 1959:
2 Set out matter
declared to in
numbered
paragraphs
ere insert
name!s",
relationship
and length of
stay of
#isitor!s"
2
I do solemnly and sincerely declare that I have the financial means and that I will provide any
necessary assistance to ensure that the visitor(s) named below hashave ade!uate funds for
personal support andor accommodation during the period of their intended visit to Australia"
#ame of visitor $elationship %ength of &tay
(&urname, 'irst #ame) (e"g" cousin, friend, etc) (e"g" ( months, etc)
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
(
% &lace
5 Day
' (onth and
year
)eclared at
*
on
+
of
,

-efore me,
) Signature of
person before
*hom the
declaration is
made !see
o#er"
.
+ ,ull name,
-ualification
and address
of person
before *hom
the declaration
is made !in
printed letters"
/
.ote 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 * years 0 see section 11 of the Statutory
Declarations Act 1959"
.ote 2 Chapter 2 of the /riminal /ode applies to all offences against the Statutory Declarations Act
1959 0 see section +A of the Statutory Declarations Act 1959"
1
A statutory declaration under the Statutory Declarations Act 1959 may be made before
(1) a person who is currently licensed or registered under a law to practise in one of the following occupations1
Chiropractor )entist %egal practitioner 2sychologist
3edical practitioner #urse 4ptometrist 5rade marks attorney
2atent attorney 2harmacist 2hysiotherapist 6eterinary surgeon
(2) a person who is enrolled on the roll of the &upreme Court of a &tate or 5erritory, or the 7igh Court of Australia, as a legal practitioner
(however described)8 or
(() a person who is in the following list1
Agent of the Australian 2ostal Corporation who is in charge of an office supplying postal services to the public
Australian Consular 4fficer or Australian )iplomatic 4fficer (within the meaning of the /onsular ,ees Act 1955)
-ailiff
-ank officer with + or more continuous years of service
-uilding society officer with + or more years of continuous service
Chief e9ecutive officer of a Commonwealth court
Clerk of a court
Commissioner for Affidavits
Commissioner for )eclarations
Credit union officer with + or more years of continuous service
:mployee of the Australian 5rade Commission who is1
(a) in a country or place outside Australia8 and
(b) authorised under paragraph ( (d) of the /onsular ,ees Act 19558 and
(c) e9ercising his or her function in that place
:mployee of the Commonwealth who is1
(a) in a country or place outside Australia8 and
(b) authorised under paragraph ( (c) of the /onsular ,ees Act 19558 and
(c) e9ercising his or her function in that place
'ellow of the #ational 5a9 Accountants; Association
'inance company officer with + or more years of continuous service
7older of a statutory office not specified in another item in this list
<udge of a court
<ustice of the 2eace
3agistrate
3arriage celebrant registered under &ubdivision C of )ivision 1 of 2art I6 of the (arriage Act 19'1
3aster of a court
3ember of Chartered &ecretaries Australia
3ember of :ngineers Australia, other than at the grade of student
3ember of the Association of 5a9ation and 3anagement Accountants
3ember of the Australasian Institute of 3ining and 3etallurgy
3ember of the Australian )efence 'orce who is1
(a) an officer8 or
(b) a non=commissioned officer within the meaning of the Defence ,orce Discipline Act 19+2 with + or more years of
continuous service8 or
(c) a warrant officer within the meaning of that Act
3ember of the Institute of Chartered Accountants in Australia, the Australian &ociety of Certified 2ractising Accountants or the
#ational Institute of Accountants
3ember of1
(a) the 2arliament of the Commonwealth8 or
(b) the 2arliament of a &tate8 or
(c) a 5erritory legislature8 or
(d) a local government authority of a &tate or 5erritory
3inister of religion registered under &ubdivision A of )ivision 1 of 2art I6 of the (arriage Act 19'1
#otary public
2ermanent employee of the Australian 2ostal Corporation with + or more years of continuous service who is employed in an
office supplying postal services to the public
2ermanent employee of1
(a) the Commonwealth or a Commonwealth authority8 or
(b) a &tate or 5erritory or a &tate or 5erritory authority8 or
(c) a local government authority8
with + or more years of continuous service who is not specified in another item in this list
2erson before whom a statutory declaration may be made under the law of the &tate or 5erritory in which the declaration is
made
2olice officer
$egistrar, or )eputy $egistrar, of a court
&enior :9ecutive &ervice employee of1
(a) the Commonwealth or a Commonwealth authority8 or
(b) a &tate or 5erritory or a &tate or 5erritory authority
&heriff
&heriff;s officer
5eacher employed on a full=time basis at a school or tertiary education institution
2