Country/State: [Your Country/State Name]

Introduction

I, [Your Name], being of legal age, sound mind, and under penalty of perjury, hereby depose and state as follows regarding the circumstances surrounding my engagement with [Your Company Name].

Statement of Facts

1. On [Month Day, Year], I entered into a contractual agreement with [Your Company Name] for the provision of travel services, including flight reservations, accommodation bookings, and transportation arrangements.

2. The terms of the agreement were outlined in a written contract, a copy of which is attached hereto as [Exhibit A] for reference.

3. Pursuant to the terms of the contract, I made payments totaling [$400] to [Your Company Name] for the specified services, as evidenced by receipts and transaction records provided by the agency.

4. On [Month Day, Year], I embarked on my trip as arranged by [Your Company Name], following the itinerary and accommodations outlined in the travel documentation provided by the agency.

5. Throughout my travels, I encountered no issues or discrepancies with the services provided by [Your Company Name], and all arrangements were executed as agreed upon in the contract.

6. I have retained all relevant documents and communications exchanged with [Your Company Name] as evidence of the terms and conditions of our contractual agreement and the satisfactory fulfillment of services rendered.

Sworn Oath

I solemnly swear that the facts stated above are true and accurate to the best of my knowledge and under penalty of perjury under the laws of [Your State/Country Name].

Signature

[Your Name]

Date: [Month Day, Year]

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