I, A. B. of, do solemnly and sincerely declare (a) that I am entitled to hold the pawn-ticket in respect of the article (or articles) described below, (b) that the said pawn-ticket has been* and (c) that the said pawn-ticket has not been sold or transferred by me to any person.
*State whether lost, mislaid, destroyed, stolen or taken by fraud.
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 mat
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