Northern Territory of Australia Prostitution Regulation Act Section 9(2) Statutory Declaration by a Prostitute I, (1) (1) Insert full name of (2) (2) Residential address previously resident at do solemnly and sincere declare as follows: My maiden name is (3) (3) If you do not have My married name is one of these types (3) of name (e.g. you are not married) My working name is (3) please write “not applicable” in the appropriate blank My alias or work name is (3) space My date of birth is I was born in (4) (4) Write down the Physical description: town, the State or Territory and the country in which I am cm tall you were born I weigh Kg My complexion is (5) (5) E.g. black, fair, olive The colour of my eyes are My natural hair colour is My present hair colour is I have the following distinguishing features (6) (6) E.g. any tattoos or scars you may have and where they are on your body I have / have not been convicted in the last 10 years of (7) (7) committing a serious drug offence or a violent offence, as Delete as applicable those offences are defined in section 9(11) of the Prostitution Regulation Act, or of attempting to commit such an offence.
Northern Territory of Australia Prostitution Regulation Act Section 9(2) Statutory Declaration by a Prostitute (1) Insert full name (2) Residential address (3) If you do not have one of these types of name (e.g. you are not married) please write “not applicable” in the appropriate blank space (4) Write down the town, the State or Territory and the country in which you were born (5) E.g. black, fair, olive (6) E.g. any tattoos or scars you may have and where they are on your body (7) Delete as applicable I, (1) of (2) previously resident at do solemnly and sincere declare as follows: My maiden name is (3) My married name is (3) My working name is (3) My alias or work name is (3) My date of birth is I was born in (4) Physical description: I am cm tall I weigh Kg My complexion is (5) The colour of my eyes are My natural hair colour is My present hair colour is I have the following distinguishing features (6) I (7) have / have not been convicted in the last 10 years of committing a serious drug offence or a violent offence, as those offences are defined in section 9(11) of the Prostitution Regulation Act, or of attempting to commit such an offence.
form-escort-stat-dec.docx