I the undersigned certify that the information indicated on this form is true and accurate. I further certify that the Declaration of Living Status is to be recorded by the People's Court of Terra Australis for preservation in the Book of Deeds.

​I understand that by submitting this declaration online, I have agreed to the electronic autograph below and that this application shall have the same legal effect as if made under oath. I am also aware that by submitting false information on this application I would be guilty of committing perjury, for which I may be prosecuted. I accept full liability for this submission.

Autograph of Living Man/Woman

Email Address of Living Man/Woman