I, [insert name of declarant] do solemnly and sincerely declare that [content of declaration].
And I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Oaths Act 1936.
[Signature of witness]
John Citizen, health practitioner
If a witness falls into more than one category (e.g. Justice of the Peace and permanent employee of a State authority with 5 or more years of continuous service) only one category need be specified.