Annex A2 - Model layout for statutory declaration/affidavit

Date Published



In the matter of Trade Mark application/s

no/s..............................for the Trade Mark the name of


1. [Insert translator's declaration if appropriate.]   

2. I, [name], of [address], being the [position of declarant] of [company], a position which I have held since [year], solemnly declare that the evidence herein comes from [source of information] and I am duly authorised to speak on my company's behalf in the prosecution of this application.   

3. The Trade Mark [application number] was first used in [area, state or country] in [month and year] by [name of first user], who is/are [the applicant/s  / the predecessor in title of the applicant/s].

[More explanation may be given if appropriate].

4. The goods and/or services in respect of which the trade mark has been used and the date of first use are as follows:

[item or group of items] first used in [year]   

5. Exhibits demonstrating use of the trade mark [exactly as applied for / in the form/s actually used by the applicant] are attached to this [statutory declaration / affidavit] and are listed as follows: [insert list clearly identifying exhibits. These should be submitted in electronic format via eServices. Please follow the guidelines on file types and file sizes when using eServices.

6. Turnover* figures for the [number] years immediately prior to the date of filing are as follows: [insert list showing each year, corresponding amount in Australian dollars, and corresponding  number of units/transactions].


Turnover* figures since filing are as follows: [insert list showing each year, corresponding amount or estimate in Australian dollars, and corresponding number of units/transactions].

* Note: state whether figures are ex-factory, wholesale or retail (in the case of goods), or are fees for services rendered.

7. The trade mark has been used upon the goods/services in the following states and territories of Australia : [insert list]   

AND has also been used in overseas jurisdiction/s [insert list]   

OR The trade mark has not been used upon the goods/services in Australia, but has been used in the following overseas jurisdiction/s: [insert list]   

8. The trade mark has been promoted by means of: [list advertising media and strategies used] and the following sums expended annually on advertising: [list amounts or estimates of expenditure by year].   

9. Any other relevant information.   


And I make this solemn declaration conscientiously believing the same to be true under the provisions of [insert name and year of Act under which declaration is made].


And I make this Affidavit conscientiously believing it to be true.



[State place at which declaration is made]