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FOOD
Statutory Declaration Form (F2) SAFETY
Statutory Declarations Act 1959 F RST

PLEASE READ CAREFULLY BEFORE COMPLETING AND SUBMITTING THIS DOCUMENT

Purpose of this form
A Statutory Declaration is a written statement that allows a person to declare
something to be true. By completing and signing this form you are declaring that
the work you have provided is your own.
Instructions
Please ensure you have read the form entirely before completing. Requests
will not be actioned unless this form is completed as required. If this form is
incomplete when submitted to us, it will not be returned to you.
This form must be signed in the presence of an authorised witness
• Please use black or blue pen
• Print clearly in block letters
If you require assistance in completing this form, please contact us at
support@foodsafetyfirst.com.au or by calling 1300 856 836.
Lodgement
Once you have completed this form, please return to us by uploading it via the
Final Submission on your course page.
Your Privacy
Your personal information is protected by law. Food Safety First collects and
stores the personal information of our students and customers for the purpose of
delivering vocational education and training.
Any data collected by the Food Safety First complies with the Privacy Act 1988
(Commonwealth).

STATUTORY DECLARATION - STATUTORY DECLARATIONS ACT 1959 (COMMONWEALTH OF AUSTRALIA)

WHEN YOU MAKE A STATUTORY DECLARATION, YOU ARE DECLARING THAT THE STATEMENTS IN IT ARE TRUE. IF YOU INTENTIONALLY MAKE A FALSE STATEMENT IN A DECLARATION, YOU CAN BE
CHARGED WITH AN OFFENCE. THE PENALTY FOR MAKING A FALSE STATEMENT IN A STATUTORY DECLARATION IS A MAXIMUM OF FOUR YEARS IMPRISONMENT.

1. Name and address of the person

I,
making the declaration

of

Declare under the Statutory Declarations Act 1959 that all work submitted for assessment is my own and I have undertaken
the following course without assistance from any person unless authorised by Food Safety First.

2. Name of the course that you have

undertaken

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 declare that the statements in this declaration are true.

3. Signature of person making the

declaration

4. Location, Day, Month and Year

Declared at

on

Before me,

5. Signature of person before whom

the declaration is made
Signature
✍
6. Full name, qualification and
address of person before whom the
Full Name
declaration is made

Qualification

Address

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Copyright 2016 © Food Safety First. All Rights Reserved.
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 • Judge of a court
of the following occupations: • Justice of the Peace
• Magistrate
• Chiropractor • Marriage celebrant registered under Subdivision C of Division 1 of Part IV of
• Dentist the Marriage Act 1961
• Legal practitioner • Master of a court
• Medical practitioner • Member of Chartered Secretaries Australia
• Nurse • Member of Engineers Australia, other than at the grade of student
• Optometrist • Member of the Association of Taxation and Management Accountants
• Patent attorney • Member of the Australasian Institute of Mining and Metallurgy
• Pharmacist • Member of the Australian Defence Force who is:
• Physiotherapist a. an officer
• Psychologist b. a non-commissioned officer within the meaning of the Defence Force
• Trade marks attorney Discipline Act 1982 with 5 or more years of continuous service
• Veterinary surgeon c. a warrant officer within the meaning of that Act
• Member of the Institute of Chartered Accountants in Australia, the Australian
2. a person who is enrolled on the roll of the Supreme Court of a State or Society of Certified Practising Accountants or the National Institute of
Territory, or the High Court of Australia, as a legal practitioner (however • Accountants
described) • Member of:
a. the Parliament of the Commonwealth
3. A person who is in the following list: b. the Parliament of a State
c. a Territory legislature
• A
 gent of the Australian Postal Corporation who is in charge of an office d. a local government authority of a State or Territory
supplying postal services to the public • Minister of religion registered under Subdivision A of Division 1 of Part IV of
• A
 ustralian Consular Officer or Australian Diplomatic Officer (within the the Marriage Act 1961
meaning of the Consular Fees Act 1955) • Notary public
• Bailiff • Permanent employee of the Australian Postal Corporation with 5 or more years
• Bank officer with 5 or more continuous years of service of continuous service who is employed in an office supplying postal services
• Building society officer with 5 or more years of continuous service to the public
• Chief executive officer of a Commonwealth court • Permanent employee of:
• Clerk of a court a. the Commonwealth or a Commonwealth authority
• Commissioner for Affidavits b. a State or Territory or a State or Territory authority
• Commissioner for Declarations c. a local government authority with 5 or more years of continuous service
• Credit union officer with 5 or more years of continuous service who is not specified in another item in this list
• Employee of the Australian Trade Commission who is: • Person before whom a statutory declaration may be made under the law of
a. in a country or place outside Australia; and the State or Territory in which the declaration is made
b. authorised under paragraph 3 (d) of the Consular Fees Act 1955; and • Police officer
c. exercising his or her function in that place • Registrar, or Deputy Registrar, of a court
• Employee of the Commonwealth who is: • Senior Executive Service employee of:
a. in a country or place outside Australia; and a. the Commonwealth or a Commonwealth authority; or
b. authorised under paragraph 3 (c) of the Consular Fees Act 1955; and b. a State or Territory or a State or Territory authority
b. exercising his or her function in that place • Sheriff
• Fellow of the National Tax Accountants’ Association • Sheriff’s officer
• Finance company officer with 5 or more years of continuous service • Teacher employed on a full-time basis at a school or tertiary education
• Holder of a statutory office not specified in another item in this list institution