Commonwealth of Australia
STATUTORY DECLARATION
Statutory Declarations Act 1959
LETTER OF INVITATION
I
Name		
Address Street Name and No.		
Suburb and Postcode		
Phone Office hours		
After hours		
Mobile		
Occupation		

make the following declaration under the Statutory Declarations Act 1959: I invite
The Nominee Full Name		
Date of birth	Date of Birth		
Address	Town/village		
	Street address		
Relationship to me		

I confirm, that during the stay in Australia I will provide the nominee accommodation, food, financial assistance and will cover the actual medical expenses if any.
Further I confirm that any visitor I have previously formally invited in the last five years has complied with all of their visa conditions. I agree to accept responsibility for: All financial obligations to the Commonwealth incurred by those I am inviting arising out of the applicant’s stay in Australia, and compliance by those I am inviting with all relevant legislation, unless the Minister decides otherwise, compliance by those I am inviting with the conditions under which they may be allowed to enter Australia.
I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in  every particular.

Signature of person making the declaration	
	
Declared at (City or place)	City or place		
Date (day/month/year)	Day / Month / Year		
Before me
Signature of person before whom the declaration is made	
	
Name	Name		
Qualification	Qualification		
Address	Street Name and No.		
	Suburb and Postcode		

Note 1 A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment for a term of 4 years — see section 11 of the Statutory Declarations Act 1959.
Note 2 Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959 — see section 5A of the Statutory Declarations Act 1959.