Fill in Signature Change and Verification Affidavit

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Signature Change and Verification Affidavit

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SIGNATURE CHANGE / SIGNATURE VERIFICATION AFFIDAVIT

I, __________, __________, resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:

1. MY SIGNATURES

1.1 I have signed in two ways at different times, and specimens of both are given in paragraph 3.

2. WHAT THIS AFFIDAVIT CONFIRMS

3. SPECIMEN SIGNATURES

3.1 Old Signature: ______________________________

3.2 New Signature: ______________________________

4. RECORD AND OFFICE

4.2 I will sign again before an officer of that institution if asked, and I understand that the institution decides whether, and from what date, it will act on this affidavit.

5. DECLARATION

5.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material. I am aware that making a false declaration in an affidavit is an offence.

VERIFICATION

DEPONENT

Signature: ______________________________
__________

ATTESTATION

Notary Public / Oath Commissioner
Registration No. and seal: ____________________

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