Statutory Declaration of Marital Status
Province/Territory/State:
Country:
Declarant Information
Full Name:
Date of Birth:
Address:
I, the undersigned, solemnly declare as follows:
Marital Status
My current marital status is as follows:
Single
Married
Divorced
Widowed
Other:
Additional Details (if required):
Declared before me at
on this
day of
,
Signature of Declarant
Signature of Notary Public / Commissioner
Name and Stamp: