Sworn Statement Template

SWORN STATEMENT

I, [Full Legal Name], of [Address], being duly sworn, do hereby declare and state under oath the following:

1. Declarant Information

• Full Name: [Full Legal Name]

• Date of Birth: [MM/DD/YYYY]

• Address: [Full Address]

• Identification Number (if applicable): [ID / Passport No.]

2. Statement of Facts

I affirm the following facts to be true and accurate to the best of my knowledge:

[Insert numbered list of facts being declared.]

3. Purpose of Statement

This sworn statement is provided for the purpose of [Describe reason, e.g., legal proceedings, insurance claim, financial verification, administrative requirement].

4. Affirmation

I declare under oath and penalty of perjury that the facts stated herein are true and correct. I understand that false statements may result in criminal or civil liability.

5. Execution

Executed this [Day] of [Month, Year], at [City, State/Country].

Declarant Signature: _______________________________
Printed Name: ___________________________________

6. Notary / Authorized Officer Acknowledgment

On this [Day] of [Month, Year], before me, [Name of Notary/Officer], personally appeared [Declarant’s Full Name], known to me (or satisfactorily proven) to be the individual who executed the foregoing Sworn Statement, and acknowledged it to be true and correct.

Notary / Officer Signature: __________________________
Printed Name: ____________________________________
Commission No.: _________________________________
My Commission Expires: ___________________________