SEPARATION DECLARATION
DECLARANT DETAILS
Your Full Legal Name:
____________________________
Your Residential Address:
____________________________
Your Spouse's Full Legal Name:
____________________________
Your Spouse's Residential Address:
____________________________
Date of Separation:
____________________________
Date of Marriage:
____________________________
DECLARATION
I, ____________________________
of ____________________________
declare as follows:
1. I am married to ____________________________
and we were married on ____________________________
2. I have decided to end my marital relationship with my spouse, and confirm that my spouse and I separated on the following date: ____________________________
3. I do not intend to resume our marital relationship and do not believe there is a reasonable likelihood of our marital cohabitation being resumed.
4. This declaration is made to record my decision and the asserted date of separation, having regard to sections 48 and 49 of the Family Law Act 1975 (Cth).
SIGNATURE OF DECLARANT
Date of Declaration
Signature
Full Name
WITNESS (Any person aged 18 or over)
Signature
Full Name
Residential Address
Date
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