Oaths Act 1867 - 1988

QUEENSLAND

TO WIT }

I,______________________________________________________________________________

of _________________________________________________________________, in the state of

Queensland,

do solemnly and sincerely declare that:

AND I MAKE THIS SOLEMN DECLARATION CONSCIENTIOUSLY BELIEVING THE SAME TO BE TRUE, AND BY VIRTUE OF THE PROVISIONS OF THE OATHS ACT 1867 – 1988.

Signature: ________________________________________

(sign only in the presence of JP or CDec)

Taken and Declared before me, at__________________________}

This___________________ day of ___________________20 }

A Justice of the Peace

or Commissioner for Declarations