[{"id":"5f47c28a-be07-4cfe-b024-a60939866e07","order":1,"text":"STATUTORY DECLARATION","fontSize":"22","textAlign":"center","bold":true,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"d3bae9b8-8db7-4395-b57a-9f0de10bae76","order":2,"text":"Change of Name Usage Declaration","fontSize":"16","textAlign":"center","bold":true,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"a31c7b8e-af7d-43bb-bd94-13137c92f955","order":3,"text":"Declaration confirming the use of a name and explaining differences in name across documents","fontSize":"12","textAlign":"center","bold":false,"underline":false,"marginBottom":"18","cflou":false,"active":true},{"id":"b1339f07-c229-482f-b14c-e025b54c6950","order":4,"text":"Made under the Statutory Declarations Act 1959 (Cth).","fontSize":"12","textAlign":"center","bold":false,"underline":false,"marginBottom":"24","cflou":false,"active":true},{"id":"60521302-7415-4d78-8b00-399f1d893049","order":5,"text":"I, [Full legal name], of [Residential address], [Occupation], do solemnly and sincerely declare that:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"18","cflou":false,"active":true},{"id":"fabab1af-8193-4ea6-9cd7-f31b716ccc93","order":6,"text":"1. CONFIRMATION OF IDENTITY","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"sectionNum":"S01"},{"id":"929f6cbe-cab9-409b-bfed-56bd09a0b1e4","order":7,"text":"I am the person named in this declaration. My correct and current full legal name is [Full legal name]. I was born on [Date of birth] at [Place of birth].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"2cffa863-0a3c-4384-891c-a481e8b90051","order":8,"text":"The name that I use and am known by for all purposes, including with banks, financial institutions and government bodies, is [Name in use].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"0063c702-826e-446b-a8c2-945b11b17d12","order":9,"text":"Each of the names referred to in this declaration is, and at all material times has been, a name of one and the same person, namely me. There is no other person to whom those names refer.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true},{"id":"a0540d69-5410-478b-a05c-8eaabff63504","order":10,"text":"2. EXPLANATION OF THE DIFFERENCE IN NAMES","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"sectionNum":"S02"},{"id":"ff55fd6a-ab56-4412-9e0d-9ec3d1eea694","order":11,"text":"Following my marriage on [Date of marriage], I adopted my spouse's surname. My name before marriage was [Name before marriage], and my name after marriage is [Name after marriage]. Both names refer to one and the same person.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"7428345d-fc8c-4ab5-bc2b-3a8e7fbe87e2","value":"marriage","type":"add","operator":"="}]},{"id":"f2952a6d-41ea-4b37-ab28-386e5f6268f9","order":12,"text":"Following the dissolution of my marriage, I have reverted to my former surname. During my marriage I was known as [Name used during marriage], and I have since resumed the use of my former name, [Former name resumed]. Both names refer to one and the same person.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"7428345d-fc8c-4ab5-bc2b-3a8e7fbe87e2","value":"divorce","type":"add","operator":"="}]},{"id":"8aa68915-62a5-4fb7-8493-ffed5a6f400a","order":13,"text":"I formally changed my name by registration with the Registry of Births, Deaths and Marriages. My previous name was [Previous registered name] and my new registered name is [New registered name]. The change was registered on [Date of registration]. Both names refer to one and the same person.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"7428345d-fc8c-4ab5-bc2b-3a8e7fbe87e2","value":"change","type":"add","operator":"="}]},{"id":"c05b77cf-6bd3-4398-a6b3-20daec8ebdb3","order":14,"text":"The difference between my documents is a discrepancy in the spelling, order or format of my name and does not reflect any change of identity. My name is variously recorded as [Name as recorded, version A] and as [Name as recorded, version B]. These are one and the same person, namely me.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"7428345d-fc8c-4ab5-bc2b-3a8e7fbe87e2","value":"spelling","type":"add","operator":"="}]},{"id":"6c826a1e-98fa-4577-8d02-bf72d53a53a6","order":15,"text":"I am commonly known by a preferred name that differs from the name shown on some of my official documents. My name as shown on official records is [Name on official records], while the name I use in everyday and commercial dealings is [Preferred name in use]. Both names refer to one and the same person.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"7428345d-fc8c-4ab5-bc2b-3a8e7fbe87e2","value":"preferred","type":"add","operator":"="}]},{"id":"af99c454-d4e8-4a6c-a408-b9c7c119c6ff","order":16,"text":"3. OTHER NAMES BY WHICH I HAVE BEEN KNOWN","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"7530b32b-b1d7-46eb-950f-e9d713eac1d3","value":"1","type":"add","operator":"="}],"sectionNum":"S03"},{"id":"803a8bc3-2330-4f8d-9c9e-7968619c5a95","order":17,"text":"In addition to the names set out above, I have also been known by the following [number] other names, and my records may appear in them. Each of them refers to one and the same person, namely me.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"7530b32b-b1d7-46eb-950f-e9d713eac1d3","value":"1","type":"add","operator":"="}]},{"id":"e81a309c-fece-4f70-9567-55d777c9f483","order":18,"text":"Other name: [Other name 1].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true,"displayConditions":[{"field":"7530b32b-b1d7-46eb-950f-e9d713eac1d3","value":"1","type":"add","operator":"="}]},{"id":"4ff8db04-09b1-4b85-942e-7f01ab2999b7","order":19,"text":"Other name: [Other name 2].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true,"displayConditions":[{"field":"7530b32b-b1d7-46eb-950f-e9d713eac1d3","value":"1","type":"add","operator":"="}]},{"id":"00c175df-b5de-47ac-ab42-9ccc56fa7eba","order":20,"text":"Other name: [Other name 3].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"57fc5fe3-9dca-4241-a794-0ae16b7cdada","value":"three","type":"add","operator":"="},{"field":"7530b32b-b1d7-46eb-950f-e9d713eac1d3","value":"0","type":"remove","operator":"="}]},{"id":"27c2a80a-23f3-465b-9ae5-014e0cf44444","order":21,"text":"4. DOCUMENTS AFFECTED","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"sectionNum":"S04"},{"id":"6b1835b2-9581-41de-8432-507be0e0dd07","order":22,"text":"The following documents are held in, or refer to, the differing names described above:","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"4da86170-9b27-44eb-a415-1905a63d8783","order":23,"text":"Documents in the name of [First name/spelling]: [List of documents].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"e5163d1b-30e9-4f2a-8bf6-641350bcb17b","order":24,"text":"Documents in the name of [Second name/spelling]: [List of documents].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true},{"id":"d3395e0d-f488-4fc9-a5bf-9745b7f4a081","order":25,"text":"5. VERIFICATION OF MY IDENTITY","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"35196d50-6b5f-4545-b3e2-779fc7ee45f4","value":"1","type":"add","operator":"="}],"sectionNum":"S05"},{"id":"d41e6947-0939-4895-81d7-f5046d4db856","order":26,"text":"My identity may be verified by reference to my [Type of identity document], bearing number [Identity document number], issued in the name of [Name shown on that document], a copy of which I am able to produce on request.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"35196d50-6b5f-4545-b3e2-779fc7ee45f4","value":"1","type":"add","operator":"="}]},{"id":"da75fd97-5e6a-43fd-8ba8-15bd682f8e9d","order":27,"text":"6. SUPPORTING EVIDENCE","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f5daf6d4-7e68-4392-b0de-d56e5f7c3f8b","value":"1","type":"add","operator":"="}],"sectionNum":"S06"},{"id":"3189c28f-0c1d-48d2-9d47-6cf2d2d92337","order":28,"text":"In support of this declaration, I attach or can produce the following evidence linking the differing names to one and the same person: [Description of supporting evidence].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"f5daf6d4-7e68-4392-b0de-d56e5f7c3f8b","value":"1","type":"add","operator":"="}]},{"id":"e54e3bc8-6204-432f-af91-6c2a61fa6c1a","order":29,"text":"7. PURPOSE OF THIS DECLARATION","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"7aedfbcd-187f-4180-9315-01138fa16759","value":"1","type":"add","operator":"="}],"sectionNum":"S07"},{"id":"7a5ba44b-1f56-4920-8eb8-674fea03dfee","order":30,"text":"This declaration is made for the purpose of [Purpose, e.g. updating my bank records], and I request that the recipient accept it as evidence that the differing names refer to one and the same person.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"7aedfbcd-187f-4180-9315-01138fa16759","value":"1","type":"add","operator":"="}]},{"id":"db328b3c-9d77-44ec-9bc1-38c297baa5ec","order":31,"text":"8. NAME TO BE USED GOING FORWARD","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"bf67eac0-c6b8-4459-8928-6bed3369d6e6","value":"1","type":"add","operator":"="}],"sectionNum":"S08"},{"id":"fd4c6ac4-8974-4200-ad67-8a6cfab7b914","order":32,"text":"From the date of this declaration, I intend to use the name [Name to be used going forward] consistently for all future dealings, and I ask that my records be updated accordingly.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"bf67eac0-c6b8-4459-8928-6bed3369d6e6","value":"1","type":"add","operator":"="}]},{"id":"d9ba0170-88a6-4b0b-99d8-32be72f33c07","order":33,"text":"9. AUTHORITY TO RELY ON THIS DECLARATION","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"sectionNum":"S09"},{"id":"ce8b70e4-849c-4613-a503-1dfc259c3d99","order":34,"text":"I authorise any bank, financial institution, government department, agency or other person to whom this declaration is produced to rely upon it, and to update their records accordingly, as evidence that the names referred to in this declaration are names of one and the same person, namely me.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true},{"id":"1b993618-f087-4c35-9223-cb9628a97376","order":35,"text":"10. DECLARATION","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"8","cflou":false,"active":true,"sectionNum":"S10"},{"id":"e8b578c3-022d-4292-81c3-51dd0dcc400b","order":36,"text":"I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Statutory Declarations Act 1959 (Cth). I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"24","cflou":false,"active":true},{"id":"07e30aa9-6ae9-457f-935a-c1c5b46cb1af","order":37,"text":"Declared at [Place of signing] on [Date of signing].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"24","cflou":false,"active":true},{"id":"baba2cc5-af64-4623-bee0-cd61683d6dce","order":38,"text":"________________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"321d8736-6dff-421e-9ad4-74f61b890437","order":39,"text":"Signature of declarant","fontSize":"12","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"80ee406d-6073-4137-b140-1aa057c00298","order":40,"text":"[Full legal name]","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"24","cflou":false,"active":true},{"id":"25e8fc72-ac5e-4cae-8d90-c2674cddef92","order":41,"text":"STATEMENT OF AUTHORISED WITNESS","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"9311c2ea-38d6-427e-a683-13ea2f1d9837","order":42,"text":"I, [Full name of witness], certify the following matters concerning this statutory declaration.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"f605d7cf-cbb9-4e0a-9f8e-acf774e928b2","order":43,"text":"I am a person authorised under the law under which this declaration is made to witness a statutory declaration, in my capacity as [Qualification of witness].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"2356ad14-6ec9-46a8-a7a1-c0c096c5f96d","order":44,"text":"This declaration was signed and declared before me by the declarant on [Date witnessed] at [Place where witnessed].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"5443019d-591b-4091-9098-270e8fdb0fc9","order":45,"text":"I saw the face of the declarant.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"ddeb500d-da2d-4a93-8216-ba56e3968c16","order":46,"text":"I have known the declarant for a period of at least 12 months.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"7dca2081-c988-41d8-9961-a1a86f716c17","value":"known","type":"add","operator":"="}]},{"id":"b696c558-c324-4cb3-bf61-1b6d6b2f956c","order":47,"text":"I have confirmed the declarant's identity by sighting an identity document, being [Identity document sighted].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"16","cflou":false,"active":true,"displayConditions":[{"field":"7dca2081-c988-41d8-9961-a1a86f716c17","value":"sighted","type":"add","operator":"="}]},{"id":"53dd4867-b291-4f15-8fa9-f6ea023f5e76","order":48,"text":"________________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"b447e9bc-5698-4791-9353-6d80a487d76a","order":49,"text":"Signature of authorised witness","fontSize":"12","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"ddbbed70-e518-4e4b-9801-956cf46c1edd","order":50,"text":"[Full name of witness]","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"364bc70e-8058-46e0-838d-9f2191ee152d","order":51,"text":"Capacity: [Qualification of witness]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"56e6e5bf-2ed1-4910-9c2e-dc82198f26a5","order":52,"text":"Address: [Address of witness]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true}]