STATUTORY DECLARATION OF ELLIOT MARCUS CHEN
Important jurisdiction and formalities warning
This fictional document is an illustrative statutory declaration only. A statutory declaration has legal effect only where the receiving law recognises it and where its prescribed wording, authority, witnessing method, identity checks and filing requirements are followed. The authorised witness may need to be a notary, lawyer, justice of the peace, commissioner or another person specified by statute. Some authorities require their own form and do not accept a general declaration. Confirm the destination authority’s rules before signing; this sample does not claim universal legal validity.
1. Declarant and administrative purpose
I, Elliot Marcus Chen, of 8 Wrenfield Court, Lakehurst, North Territory 77102, civil engineer, make this declaration for the North Territory Vehicle Licensing Office in support of my application to replace the registration certificate for my 2020 Aster Rowan electric utility vehicle, registration number NT-482-KL.
The vehicle is registered in my name. I am making this declaration because the original certificate was destroyed when water entered my locked document cabinet during a plumbing failure on 6 August 2026. I have searched for the original and cannot produce it. I have not sold, transferred, pledged or otherwise disposed of the vehicle.
2. Ownership and identification
I purchased the vehicle from Lakehurst Aster Motors, 240 Granite Boulevard, Lakehurst, North Territory 77101, on 14 May 2020 for 46,800 North Territory dollars, including taxes and delivery. The vehicle identification number is ARV20E-9F31-7726, and the odometer reading on the date of this declaration is 61,408 kilometres.
The vehicle is kept at my home address stated above. I use it primarily for travelling to engineering sites and carrying surveying equipment. I have maintained the vehicle, paid the applicable registration charges, and held insurance continuously since purchase, except for a three-day transfer between policies in June 2021.
3. Loss of the certificate
The original registration certificate was stored in a labelled blue folder inside a metal cabinet in my home office. At approximately 7:20 p.m. on 6 August 2026, a flexible supply pipe beneath the upstairs laundry failed. Water travelled through the ceiling into the office. My partner, Rina Patel, and I moved the folder from the cabinet at approximately 8:05 p.m. The paper had already become saturated and separated when we opened it to dry the contents.
I photographed the damaged certificate and placed the pieces in an envelope marked “Vehicle certificate — damaged.” The photographs and the envelope are still in my possession. The printed registration number and vehicle identification number remain legible, but the certificate cannot reasonably be used as an intact official record. I have not thrown it away.
I reported the plumbing incident to Harbour Mutual Insurance on 7 August 2026 under home policy HM-38190. The insurer’s claim reference is LKH-10672. Its assessor, Jenna Morris, inspected the office on 12 August 2026 and recorded water damage to the cabinet and documents. A copy of the claim acknowledgement is retained with my application.
4. Searches and absence of competing claim
On 8 August 2026, I searched the office, vehicle glove compartment, home safe, work locker and the storage box at 17 Quay Street, Lakehurst, where I kept older vehicle records. I asked Rina Patel and my employer’s office administrator, Gareth Owen, whether either had received or stored the certificate. Neither had done so. I also checked the digital vehicle portal and found the same registration number and vehicle identification number associated with my account.
To the best of my knowledge, no other person holds the original certificate. If it is later found, I will notify the Vehicle Licensing Office and return or destroy it as directed. I consent to the Office checking government, insurance and vehicle records to verify this declaration. I understand that a replacement certificate does not change ownership or permit an unregistered vehicle to be used contrary to law.
5. Request and truth statement
I request that the Vehicle Licensing Office issue a replacement registration certificate or tell me what additional evidence it requires. The information in this declaration is true and correct to the best of my knowledge and belief. I understand that making a false statutory declaration may be an offence and may invalidate or prejudice my application.
Declaration
I, Elliot Marcus Chen, solemnly and sincerely declare that the contents of this declaration are true and correct, and I make this solemn declaration conscientiously believing the same to be true and by virtue of the applicable statutory declaration law.
Declared at Lakehurst, North Territory on 22 August 2026.
Declarant signature: ____________________ Date: 22 August 2026
Before me: Miriam Adele Frost, Justice of the Peace for North Territory
Authorised witness signature: ____________________
Registration or commission number: JP-NT-19482
The receiving office and authorised witness must substitute any prescribed declaration, attestation, seal, identity verification, language or filing requirements that apply under the relevant North Territory law.