Statutory Declaration of Income

I, , of ,
solemnly declare as follows:

1. That my occupation is .
2. That my total gross monthly income is as follows:

   Source of Income	Amount (Currency)
   Total

3. That the above-stated income is true and correct to the best of my knowledge and belief.

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.