________
________
Phone: ________
Email: ________

To: ________
________

Date: ________

RE: STATUTORY DECLARATION AND CONFIRMATION OF GIFT (NON-REPAYABLE) — LOAN APPLICATION REFERENCE NO. ________

To whom it may concern:

I, ________ of ________, the donor, make this declaration in connection with the application for finance by ________ ("the Recipient") and confirm the following matters to be true and correct.

§1. The Gift

1. I confirm that I am voluntarily gifting the sum of $________ (________) ("the Gift") to the Recipient.
2. My relationship to the Recipient is that of ________.
3. The Gift will be transferred to the Recipient on or about ________ by way of ________.

§2. Nature of the Gift

1. The Gift is given absolutely, freely, voluntarily and unconditionally.
2. Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud.
3. I have no expectation of, and will not seek, repayment of the Gift or any part of it, and I will not charge any interest in respect of it.
4. I retain no legal, equitable or beneficial interest in the Gift or in any property, asset or security acquired with the Gift, including the property situated at ________ ("the Property").
5. Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis.

§3. Source of Funds

1. I am financially able to provide the Gift from my own funds and the Gift is provided wholly from those funds.
2. The Gift does not come from, and is not funded by, any borrowed money, loan, credit facility or third party.
3. The funds comprising the Gift are derived from ________.

§4. Acknowledgements

1. I understand that the lender will rely on this declaration in assessing the Recipient's application for finance, and I make it for that purpose.
2. I am not a party to, and assume no liability or obligation under, any loan, mortgage or facility entered into by the Recipient.
3. I have been given the opportunity to obtain independent legal and financial advice in relation to this declaration.

§5. Statutory Declaration

I, ________, make this solemn declaration conscientiously believing the statements contained in it to be true and correct, and by virtue of the provisions of the Statutory Declarations Act 1959 (Cth) and/or the corresponding statutory declarations legislation of ________.

Declared at ________ on ________.

Yours faithfully,

__________________________________
________
(Donor)

Witness (an authorised witness within the meaning of the applicable statutory declarations legislation):

__________________________________
Signature of witness

Name of witness: ________
Qualification of witness: ________
Address of witness: ________
Date: ________