STATUTORY DECLARATION Statutory Declaration I, (insert name) of (insert address) …….…………………. …………………...……… being the (insert position) of the ………………………….. ………………..……..….. Applicant, (insert name of applicant) …………………………………………… Hereby DECLARE that the information contained in this application, and attachments thereto upon which I have placed my signature, for the grant of a (insert type of licence applied for) licence under the ……….…………………………………… Electricity Supply Industry Act 1995 is true and correct and that I make this solemn declaration under the Oaths Act 2001. Signed: …………………………………………………………… Declared at (place): …………………………………………………………… On (date): …………………………………………………………… Before me: …………………………………………………………… (Justice, commissioner for declarations or authorised person)
STATUTORY DECLARATION Statutory Declaration I, (insert name) …….…………………. of (insert address) …………………...……… ………………………….. being the (insert position) ………………..……..….. of the Applicant, (insert name of applicant) …………………………………………… Hereby DECLARE that the information contained in this application, and attachments thereto upon which I have placed my signature, for the grant of a (insert type of licence applied for) ……….…………………………………… licence under the Electricity Supply Industry Act 1995 is true and correct and that I make this solemn declaration under the Oaths Act 2001. Signed: …………………………………………………………… Declared at (place): …………………………………………………………… On (date): …………………………………………………………… Before me: …………………………………………………………… (Justice, commissioner for declarations or authorised person)
Electricity%20Licence%20Application%20Form%20Version%205%20July%202014%20(14%202110).docx