PART A: General sautation- miss Qs ms mr Cor Cother ' PATRICK BAUTISTA, FERNANDEZ Inset ful egal nome: First name ‘Middle norme(s) Family nome of 197 TINDALAVENUE _BEELIAR WA 6164 Insert current residential address: Street adress Town/Suburb state Postcode currentlyemployedas _ SENIOR MECHANICAL ENGINEER Taser current occupation make the following declaration under the Statutory Declarations Act 1959 (Cth) in connection with the home loan application made by me to the lender and for which I have requested the lender to seek the issue of a Family Home Guarantee, a New Home Guarantee or a First Home Guarantee under the Australian Government's Home Guarantee Scheme (Scheme]: 1 ‘understand that this Home Buyer Declaration is separate to my application for a home loan made to the lender. 2 X] | have not been known by any other names | have been known by the following other names: Insert other/previous names ia fullest name, middle nerce(s), family nar 3 | have resided in each of the Australian jurisdictions marked below (including the jurisdiction where | presently reside):? New South Wales [“] Victoria Queensland X] Western Australia South Australia Tasmania [_] Australien Capital Territory [7] Northern Territory Other aa CITIZENSHIP APPLICATION APPROVED, 4 | am an Australian citizen [J True XJ False AND CEREMONY SCHEDULED ON THE 31st OF JULY 2023, 5 lam at least 18 years of age [x] True False 6 As at the date of this declaration, my relationship status is as follows: | have never been married | | am married "inser all previous names. no previous names, insert no ’no other previous names or‘notapoicable! ® Check each box (wth en’) foreach juidtion in which you have ved at anytime (including a at she date of chs declaration. For ‘stain urstons that are net specially identified ~-bing Jers Bay Terror, Neco Wand, Chistmas sand and/or Ccas (Keng) ‘lands ~ chock ‘ther’ and inser the name ofeach Such jrscetion an the line nex o that box Page 3 of 12