Sample Form - Statutory Declaration

Sample Statutory Declaration for a member to request a copy of the register of members of an association.

STATUTORY DECLARATION

Oaths, Affidavits and Statutory Declarations Act 2005

Request for a copy or extract of Association’s Register of Members (s54(3) or s56(2) of the Act)

sincerely declare as follows:

1. I am a current member of                         (insert incorporated association name) (Association).
2. My request of                                (insert date of request) to obtain a copy or extract of the register of members of the Association is made for the purpose of                          (insert purpose of obtaining information), which is connected with the Association’s affairs.
3. I declare that this purpose is connected with the affairs of the Association.
4. I understand that it is a criminal offence to disclose information in the register of members for a purpose that is not directly connected with the affairs of the Association or that is not related to the administration of the Associations Incorporation Act 2015 (Unlawful Purposes).
5. I will not disclose information obtained from the register for Unlawful Purposes.
6. I understand that Unlawful Purposes include, but are not limited to, advertising for political, religious, charitable or commercial purposes.

This declaration is true and I know that it is an offence to make a declaration knowing that it is false in a material particular.

This declaration is made under the Oaths, Affidavits and Statutory Declarations Act 2005

In the presence of:

Information about preparing and witnessing statutory declarations is available from www.courts.dotag.wa.gov.au.