A declaration made to seek exemption from jury duty because diabilities, physical/mental impairments, of the person being summonsed, mean (s)he is unable to perform the duty as juror.
A 'stat dec' form for declaration under the
in the Northern Territory. See https://nt.gov.au/law/processes/statutory-declarations This is in PDF form, useful if you wish to just print it and sign it. This may be witnessed by any person that has attained the age of eighteen. A note regarding the penalty for false declaration is included. L-0119
Stat dec (NT) seeking to be excused from jury duty due to disability.