Oaths Act 1867

STATUTORY DECLARATION

QUEENSLAND

TO WIT

I, [insert name of person signing] of [insert address] in the State of Queensland, do solemnly and sincerely declare that, in relation to the agreement between Cook Shire Council and [insert Supplier's name] (Supplier), identified as contract no. [insert contract no.] (Contract) and to purchase order number [insert purchase order number](Purchase Order) for the hire of plant on a [insert wet or dry] hire basis:

I hold the position of . Having made all reasonable inquiries, I am in a position to know the facts contained herein. I am duly authorised by the Supplier to make this declaration on its behalf.

All work undertaken and all other obligations of the Supplier pursuant to the Contract and the Purchase Order have been undertaken or satisfied in accordance with the Contract and the Purchase Order, except to the extent, if any, that the Supplier has previously notified Council to the contrary in writing.

Each claim for payment which the Supplier has submitted in connection with the Purchase Order and all documentary evidence provided in support of such claims, is true and correct in every aspect.

The records annexed to this declaration are true, correct and accurate in every respect and current as at the date of this declaration.

And I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths Act 1867.

Taken and declared at
this day of	)
before me:	)
)
Witness (Name)
Contractor’s Signature (as stated above)	Witness (Signature)