1. I
do hereby make oath and say:
(name of person)
2. I am an adult
and I live at
(male/female)
(address)
3. I am
(married/single)
unemployed/employed at………………………………………………..
4. The statement (fill in what you is true)
……………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………….
…………………………………………………………………..
DEPONENT
(the person making the statement is the deponent and must sign here but only in front of the Commissioner of oaths)
(Then Commissioner of oaths fills in this next part)
THUS SIGNED AND SWORN TO at
this day of
(place)
2015
the Deponent having acknowledged:
……………………………….
COMMISSIONER OF OATHS
(Commissioner of oaths signs here after asking the deponent
to swear with his/her hand in the air that s/he is telling the truth)
(the name and address of the Commissioner will be given here, and the office held by the Commissioner, e.g. postmaster)