I. INTRODUCTION

I, [YOUR NAME], solemnly affirm and declare under oath with utmost resolution and without any reservation that all the statements and information forthwith mentioned and provided by me are complete, accurate, and true to the greatest extent of my knowledge and belief.

II. PERSONAL INFORMATION

1. Full Name: [YOUR NAME]

2. Residential Address: [YOUR RESIDENTIAL ADDRESS]

3. Phone Number: [YOUR COMPANY NUMBER]

4. Email Address: [YOUR EMAIL]

III. NOTARY APPOINTMENT DETAILS

• Date of Appointment: [DATE OF APPOINTMENT]

• Commission Expiry Date: [COMMISSION EXPIRY DATE]

• Commission Number: [COMMISSION NUMBER]

• Jurisdiction of Commission: [JURISDICTION]

IV. AFFIRMATION STATEMENT

I, [YOUR NAME], solemnly affirm that:

• I understand the duties and responsibilities of a notary public as outlined by [YOUR STATE JURISDICTION].

• I will faithfully and impartially perform all notarial acts prescribed by law.

• I will exercise my authority as a notary public under the laws of [YOUR STATE].

• I will not engage in any fraudulent or dishonest activity related to notarial acts.

• I will maintain the integrity and confidentiality of all notarial records and information.

V. WITNESS AFFIRMATION (IF REQUIRED)

I, [WITNESS'S NAME], certify that I witnessed the signing of this affirmation by [Your Name] and that to the best of my knowledge, he/she is of sound mind and acting voluntarily.

[WITNESS'S SIGNATURE]
[PRINTED NAME OF WITNESS]
[DATE OF WITNESSING]

VI. NOTARY'S PUBLIC STATEMENT

I, [YOUR NAME], hereby certify under penalty of perjury under the laws of [YOUR STATE] that the foregoing is true and correct.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal on the date mentioned above.

[YOUR NAME] Signature:
Date: [DATE OF NOTARIZATION]

VII. NOTARY SEAL

(Place Notary Seal Here)

VIII. ACKNOWLEDGEMENT RECEIPT (OPTIONAL)

I, [RECIPIENT NAME], acknowledge the receipt of the notarized document titled [DOCUMENT TITLE] on [DATE OF RECEIPT].

Recipient Signature:

Date: [DATE OF RECEIPT]

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