Notarized Statutory Declaration for Immigration Purposes

I, (Full Legal Name): of (address): Date of Birth: Country of Citizenship:

SOLEMNLY DECLARE THAT:

Further declaration (if any):

And I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.

Declared at (City/Town):

This (Day):

Of (Month & Year):

Signature of Declarant

Commissioner for Oaths / Notary Public