DATE OF BIRTH AFFIDAVIT
Executed at __________ on __________.
I, __________, __________, resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:
- WHOSE DATE OF BIRTH
1.1 __________.
- THE DATE OF BIRTH
2.1 The date of birth is __________, at __________.
2.2 __________.
2.3 Basis of this knowledge: __________.
- PURPOSE
3.1 This affidavit is sworn for the purpose of: __________.
- DECLARATION
4.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material to this affidavit. I am aware that making a false declaration in an affidavit is an offence.
VERIFICATION
Verified at __________ on __________ that the contents of paragraphs 1 to 4 above are true and correct to my own knowledge, that no part of it is false, and that nothing material has been concealed.
DEPONENT
Signature: ______________________________
__________
ATTESTATION
Solemnly affirmed and signed before me on __________ at __________, the Deponent having been identified to my satisfaction by __________.
Notary Public / Oath Commissioner
Registration No. and seal: ____________________