Fillable Printable Statutory Declaration Form - City of Melbourne

Statutory Declaration Form - City of Melbourne

St ate of V i ctori a – E vi dence Ac t 1958

[JP/DOJ.1/2000]

STATUTORY DECLARATION

, ___________________________________________________________________ ,

[f ul l name]

of ___________________________________________________________________ ,

[address]

_______________________________ , do solemnly and sincerely declare that:-

[occupation]

I acknowledge that this declaration is true and correct, and I make it with the understanding

and beli ef t hat a person who makes a false declarat i on i s l iable t o t he penal t ies of perjury.

Declared at _________________________

in the St ate of Victor ia, this _______ day of

___________________ 20 ____ .........................................................

Signature of person m aking t hi s decl aration

[t o be signed in front of an authoris ed witnes s]

Before me,

............................................

Signature of authorised witness

The authori s ed witness must pri nt or stamp hi s or her nam e, address, and t i tle under s ecti on 107A of the E vidence Act 1958 [ Vic.]

(eg. Just i ce of the Peace, P harmacis t, P ol i ce Off i cer, Court Regis trar, B ank Manager, Medical Pract i tioner, Dentis t)

State of Victoria – Evidence Act 1958

PERSONS WHO CAN WITNESS STATUTORY DECLARATIONS

 A Justice of the Peace or a Bail Justice

 A Notary Public

 A barrister and solicitor of the Supreme Court

 A clerk to a barrister and solicitor of the Supreme

Court [barristers’ clerk]

 The Prothonotary or a Deputy Prothonotary of the

Supreme Court, the Registrar or a Deputy Registrar

of the County Court, the Principal Registrar of the

Magistrates’ Court or a Registrar or Deputy

Registrar of the Magistrates’ Court

 The Registrar of Probates or an Assistant Registrar

of Probates

 The Associate to a Judge of the Supreme Court or

of the County Court

 The Secretary of a Master of the Supreme Court or

of the County Court

 A person registered as a Patent Attorney under Part

XV of the Patents Act 1952 of the Commonwealth

 A member of the police force

 The sheriff or a deputy sheriff

 A member or a former member of either House of

the Parliament of Victoria

 A member or a former member of either House of

the Parliament of the Commonwealth

 A councillor of a municipality

 A senior officer of a Council as defined in the Local

Government Act 1989

 A registered medical practitioner within the

meaning of the Medical Practice Act 1994

 A dentist

 A veterinary practitioner

 A pharmacist

 A principal in the [State] teaching service

 The [branch] manager of a bank

 A member of the Institute of Chartered

Accountants in Australia or the Australian Society

of Accountants or the National Institute of

Accountants

 The secretary of a building society

 A minister of religion authorised to celebrate

marriages [not a civil celebrant]

 A person employed under Part 3 of the Public

Sector Management and Employment Act 1998

with a classification that is prescribed as a

classification for statutory declarations or who

holds office in a statutory authority with such a

classification

 A fellow of the Institute of Legal Executives

(Victoria)

PERSONS WHO CAN RECEIVE AFFIDAVITS

• Any Judge or the Associate to any Judge

• A Master of the Supreme Court or the County Court

or the Secretary of such a Master

• A Justice of the Peace or a Bail Justice

• The Prothonotary or a Deputy Prothonotary of the

Supreme Court, the Registrar or a Deputy Registrar

of the County Court, the Principal Registrar of the

Magistrates’ Court or a Registrar or Deputy Registrar

of the Magistrates’ Court

• The Registrar of Probates or an Assistant Registrar

of Probates

• The Registrar or Deputy Registrar of the Legal

Profession Tribunal

• A member or former member of either House of the

Parliament of Victoria

• A member or former member of either House of the

Parliament of the Commonwealth

• A Notary Public

• [Solicitor]: A natural person who is a current

practitioner or registered interstate practitioner

within the meaning of the Legal Practice Act 1996

• A member of the police force of or above the rank

of sergeant or for the time being in charge of a

police station

• A person employed under Part 3 of the Public

Sector Management and Employment Act 1998

with a classification that is prescribed for receiving

affidavits

• A senior officer of a Council as defined in the Local

Government Act 1989

• A person registered as a Patent Attorney under

Part XV of the Patents Act 1952 of the

Commonwealth

• A fellow of the Institute of Legal Executives

(Victoria)

Commonwealth of Australia

PERSONS WHO CAN WITNESS COMMONWEALTH (FEDERAL) STATUTORY DECLARATIONS

A statutory declaration under the Statutory Declarations Act 1959 (as amended) may be made before -

Part 1 - Members of Certain Professions

Chiropractor, Dentist, Legal practitioner, Medical practitioner, Nurse, Patent attorney, Pharmacist, Physiotherapist, Psychologist,

Veterin ary surgeon

Part 2 - Other Persons

Agent of the Australian Po stal Corporation who is in charge of an office supplying postal services to the public

Au stralian Consular Officer, or Au stralian Diplomatic Officer, (within the meaning of the Consular Fees Act 1955)

Bailiff

Bank officer with 5 or more continuous years of service

Building society officer with 5 or more years of continuous service

Chi ef execut ive officer of a Commonwealth court

Civil marriage celeb rant

Clerk o f a court

C ommissioner for Affida vits

Commissi oner for Declarati ons

Cred it union officer with 5 or more years of continuous service

Fellow of the National Tax Accountants’ Association

Finance company officer with 5 or more years of continuous service

Hol der of a statu tory office no t specified i n another i tem i n th i s Part

Judge of a court

Just ice of th e Peace

Magistrate

Master of a court

Member of the Association of Taxation and Management Accountants

Member of the Aust ral ian Defence Force who is:

(a) an officer; or

(b) a non-commissioned officer with the mean ing of the Defence Force Discipline Act 1982 with 5 or more years of

continuous service; or

Member of the Institute of Chartered Accountants in Au stralia, the Au stralian Society of Certified Practising Accountants or

the National Institute of Accountants

Member of the Institute of Corporate managers, Secretaries and Administrators

Member of the Institution of Engineers, Australia, other than at the grade of student

Member of:

(a) the P arliament of the Commonwealth; or

(b) the Parliament of a State; o r

(d) a l ocal government auth ority of a State or Territory

Minister of religion registered under Division 1 of P art IV of the Marriage Act 1961

Notary public

Permanent employee of:

(a) the Commonwealth or of a Commonwealth authority; or

(b) a S t at e or Territory or of a Stat e or Territory authority; or

with 5 or more years of continuous service who is not specified in another item in this Part

Permanent employee of the Australian Postal Corporation with 5 or more years of continuous service who is employed in an

office supplying postal services to the public

Person before whom a statutory declaration may be made under the law of the State or Territory in which the declaration is made

Pol ice Offi cer

Registrar, or Deputy Registrar, of a court

Sen i or Executive Service officer of the Co mmonwealth , or of a State or Territory, o r of a Commonwealth, St ate or Territory authority

Sheriff

S her iff’s officer

Teacher [includ es a l ecturer, tutor or qual i fied pri ncip al ] employed on a full-time basis at a school or tertiary education institution

PERSONS WHO CAN RECEIVE COMMONWEALTH (FEDERAL) AFFIDAVITS

Section 186 of the Commonwealth Evidence Act 1995, provides that an affidavit fo r use in federal courts, and in other courts exercising federal

ju ri sdicti on, may be sworn before any Justice of th e Peace, Notary Publ i c or Lawyer, without the issue of any commission for taking affidavits.

[1/2000]