Sixth Schedule, Part I Statutory Declaration where pledge claimed by owner
I, A. B. of, do solemnly and sincerely declare that the article (or articles) described below is (or are) my property and that I believe it is (they are) pledged at the premises of
The article (or articles) above referred to is (or are) the following: -
AND I make this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declarations Act, 1938.
(Signed) A. B.
Declared before me by A. B.
who is personally known to me (or who
is identified to me by C. D.
who is personally known to me) at
__________________________________________
this______________day of______________
__________________________________________
__________________________________________
TAKE NOTICE if this Statutory Declaration is, to the knowledge of the person making it, false or misleading in any material respect he shall be guilty of an offence and liable on summary conviction thereof to a fine not exceeding £1,500 pounds or, at the discretion of the court, to imprisonment for a term not exceeding three months or to both such fine and such imprisonment.
Unless this printed form is taken before a notary public, a commissioner for oaths or a peace commissioner and declared to and signed and delivered back to the pawnbroker not later than the day of, 19, the article (or articles) mentioned in it will be delivered to any person producing the pawn-ticket.