Form 20 – Affidavit


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QUEENSLAND INDUSTRIAL RELATIONS COMMISSION
Form 20 – Affidavit
Industrial Relations Act 2016, section 989 Industrial Relations (Tribunals) Rules 2011, rules 52, 53 and 55

Matter Number:

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Information • Please read this form carefully. Please complete all relevant sections. Information that is missing or non-compliant with the relevant section
of an Act or the Rules may result in the rejection of your form. • Practice Direction 3 of 2021 - ELECTRONIC FILING AND HARD COPIES OF DOCUMENTS. Documents which are longer than 30 pages in
length must be supplied to the Industrial Registry in hard copy before it will be accepted for filing.
For further information please contact the Industrial Registry on 1300 592 987 or via email at [email protected]
Applicant:

V Respondent:

PLEASE NOTE: If there are more than two parties to this application, please complete a Form 1 – Parties list and file it with this form. PLEASE NOTE: If this affidavit contains exhibits you will need to complete a Form 21 - Certificate of exhibit to affidavit for each exhibit. This affidavit is filed for the applicant respondent (or as the case may be)
Affidavit of (name of person making affidavit) I (Name):

of (Address): Position:
make oath and say

or solemnly and sincerely affirm and declare as follows –

QUEIRC21614

Signed: (deponent/s to sign)
© State of Queensland 2018 Form 20 – Affidavit Version 4.2

Taken by: (person taking the affidavit to sign)
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1. I am …… 2. Exhibit A to this affidavit is …….

QUEIRC21614

Signed: (deponent/s to sign)
© State of Queensland 2018 Form 20 – Affidavit Version 4.2

Taken by: (person taking the affidavit to sign)
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Further, I make oath and say solemnly and sincerely affirm and declare All the facts and circumstances deposed to in this my affidavit are within my own knowledge and belief, except for the facts and circumstances deposed to from information only, and my means of knowledge and sources of information appear on the face of this my affidavit.
Signature Signature:

Name:
Date:
Taken by Sworn/Affirmed by the deponent at: on: Signature:

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Print name:
Justice of the peace/commissioner for declarations/lawyer/other qualified person Certificate: Pursuant to section 55 of the Industrial Relations (Tribunals) Rules 2011
I certify that the affidavit was read in the presence of the deponent who seemed to understand it, and signified that that person made the affidavit. I certify that the affidavit was read in the presence of the deponent who seemed to understand it, and signified that that person made the affidavit, but was physically incapable of signing it.

QUEIRC21614

© State of Queensland 2018

Form 20 – Affidavit Version 4.2

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Form 20 – Affidavit