FORM – 7.
3 – EMPLOYMENT – STATUTORY DECLARATION
Commonwealth of Australia
STATUTORY DECLARATION
Statutory Declarations Act 1959
1 Insert the name, 1
address and I,
occupation of
person making
the declaration Make the following declaration under the Statutory Declarations Act 1959:
2 Set out matter 2.
declared to in 1. I declare that (place a tick or cross in applicable box):
numbered
paragraphs
Since turning 16 years of age, I have been a citizen or
permanent resident of a country / countries other than
Australia.
Since turning 16 years of age, I have never been a citizen or
permanent resident of a country / countries other than
Australia.
2. I declare that I have never been:
(a) Convicted of murder or sexual assault; or
(b) convicted of any other form of assault.
I understand that a person who intentionally makes a false statement in a statutory
declaration is guilty of an offence under section 11 of the Statutory Declarations Act
1959, and I believe that the statements in this declaration are true in every particular.
3 Signature of 3.
person making
the declaration
4 Place Declared at 4 Home on 5 Friday of 6 October 2024
5 Day
6 Month and year
Before me,
7 Signature of 7
person before
whom the
declaration is
made (see over)
8 Full name, 8
qualification and
address of
person before
whom the
declaration is
made (in printed
letters) Note 1 A person who intentionally makes a false statement in a statutory declaration
is guilty of an offence, the punishment for which is imprisonment for a term of 4 years
– see section 11 of the Statutory Declarations Act 1959.
Note 2 Chapter 2 of the Criminal Code applies to all offences against the Statutory
Declarations Act 1959 –see section 5A of the Statutory Declarations Act 1959
FORM – 7.3 – EMPLOYMENT – STATUTORY DECLARATION
APPENDIX 1 – STATUTORY DECLARATION
A statutory declaration under the Statutory Declarations Act 1959 may be made before –
(1) a person who is currently licensed or registered under a law to practice in one of the following
occupations:
Chiropractor Dentist Legal practitioner
Medical practitioner Nurse Optometrist
Patent attorney Pharmacist Physiotherapist
Psychologist Trade marks attorney Veterinary surgeon
(2) a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High
Court of Australia, as a legal practitioner (however described); or
(3) a person who is in the following list:
Agent of the Australian Postal Corporation who is in charge of an office supplying postal
services to the public Australian Consular Officer or Australian 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
Chief executive officer of a Commonwealth court
Clerk of a court
Commissioner of Affidavits
Commissioner for Declarations
Credit union officer with 5 or more years of continuous service
Employee of the Australian Trade Commission who is:
(a) in a country or place outside Australia; and
(b) authorized under paragraph 3 (d) of the Consular Fees Act 1955; and
(c) exercising his or her function in that place
Employee of the Commonwealth who is:
(d) in a country or place outside Australia; and
(e) authorized under paragraph 3 (d) of the Consular Fees Act 1955; and
(f) exercising his or her function in that place
Fellow of the National Tax Accountants Association
Finance company officer with 5 or more years of continuous service
Holder of a statutory office not specified in another item in this list
Judge of a court
Justice of the Peace
Magistrate
Marriage celebrant registered under Subdivision C of Division 1 of Part IV of the Marriage Act
1961
Master of a court
Member of Chartered Secretaries Australia
Member of Engineers Australia, other than at the grade of student
Member of the Australian Institute of Mining and Metallurgy
Member of the Australian Defence Force who is:
(a) an officer; or
(b) a non-commissioned officer within the meaning of the Defence Force Discipline Act 1982
with 5 or more years of continuous service; or
(c) a warrant officer within the meaning of that Act
Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified
Practising Accountants or the National Institute of Accountants
Member of:
(a) the Parliament of the Commonwealth; or
(b) the Parliament of a State; or
(c) a Territory legislature; or
(d) a local government authority of a State or Territory
Minister of religion registered under Subdivision A of Division 1 of Part IV of the Marriage Act
1961
Notary public
Permanent employee of:
(a) the Commonwealth or a Commonwealth authority; or
(b) a State or Territory or a State of Territory authority; or
(c) a local government authority
with 5 or more years of continuous service who is not specified in another item in this list
