address and occupation of person making the declaration. (2) Name of the child (3) Name of biological mother (4) Name of biological father (5) Name of birth mother () !trike out "hiche#er is not applicable I (1) , do solemnl$ and sincerel$ declare % &he biological mother of (2) (herein after kno"n as 'the child() is (3) % &he biological father of the child is (4) % &he birth mother of the child is (5) % &hat surrogac$ arrangements )*+*,)*+* N-& () used in relation to the child % &hat artificial conception procedures )*+*,)*+* N-& () used in relation to the child % &hat I ha#e not been e.cluded through a court of la" from ha#ing custod$ or legal guardianship of the child % &hat custod$ proceedings or court hearings in relation to custod$,guardianship of the child /+*,/+* N-& () presentl$ ongoing or ha#e commenced. I full$ understand the abo#e, or the abo#e has been full$ e.plained to me b$ another person or interpreter "ho full$ understands the abo#e, such that I full$ understand the abo#e. I understand that an$ incorrect information ma$ result in refusal or cancellation of the /ustralian citi0enship of the child. I make this solemn declaration b$ #irtue of the Indian Oaths Act 1969, and sub1ect to the penalties pro#ided b$ the la" for the making of false statements in s"orn statements, conscientiousl$ belie#ing the statements contained in this declaration to be true in e#er$ particular to the best of m$ kno"ledge and belief. (2) !ignature of person making the declaration (2) 3eponent )itness4 (5) !ignature of person before "hom the 6.declaration is made. (7) !ignature of person before "hom the declaration is made 1. (5). 2. (7). /ffi. IN+28 stamp here Witnessed and stamped by Notary Public N-&* 9 / person "ho "ilfull$ makes a false statement in a s"orn statement under the INDIAN OATHS ACT 1969 is guilt$ of an offence against that /ct.