Annex A3 - Model layout for supporting statutory declaration

Date Published

DECLARATION, STATUTORY DECLARATION AND AFFIDAVIT

SUPPORTING STATEMENT FOR AN APPLICATION UNDER SECTION 41 OF THE TRADE MARKS ACT

1. I, [name], of [address], being the [position] 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 support of the acceptance for registration of application [number] for the trade mark [nominate or describe] in respect of [designated goods/services] in the name of [the applicant/name of authorised user].

2.  My experience in the [trade] in [state/s of the Commonwealth] arises from [number] years in that trade. [Insert other details if appropriate.]

3. I identify this trade mark with the goods/services of the applicant only. I consider that its use by any trader other than the applicant on the goods/services designated, or on similar goods/services, could result only from an improper motive on the part of a competitor and would result in confusion and deception within the trade.   

4. I have known of the use of this trade mark by the applicant since at least [insert year].   

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].

OR

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

[SIGNATURE]

[INSERT DATE]

[State place at which declaration is made]

and

[SIGNATURE OF AUTHORISED WITNESS]