Signature of witness. Address of Witness
Signature of witness. Date .......................................................... I have accurately read out the explanatory letter and State School Consent Form to the potential consenter, and to the best of my ability made sure that the person understands that the following will be done:
Signature of witness. Name of witness (print) ......................................................................................Name of officer (print) ...................................................................................
Signature of witness. Name of witness (block letters)
Signature of witness. Name of witness (print) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature of authorised person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Signature of witness. Signature .......................................................................
Signature of witness. Name of witness (block letters) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ...............................................................
Signature of witness. Signature of authorised representative .................................................................
Signature of witness. Note: 1) Failure to complete the declaration will lead to the rejection of a claim for a preference.
Signature of witness. OCCUPATION ..............................................
