Free 30+ Self-Declaration Letter Format Examples [Health, Travel]

[Your Full Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Date]

[Recipient’s Name or Designation, if applicable]
[Company or Organization Name, if applicable]
[Address, if applicable]
[City, State, ZIP Code]

Subject: Self-Declaration Letter

Dear [Recipient’s Name or Sir/Madam],

I, [Your Full Name], residing at [Your Address], hereby declare and confirm the following information:

1. I declare that the information provided in this letter is true and accurate to the best of my knowledge.
2. I confirm that I am [your age] years old as of [current date].
3. I declare that I am a [your nationality] citizen.
4. I affirm that I am currently employed/self-employed at [Your Employer’s Name or Business Name] and my current designation/occupation is [Your Designation or Occupation].
5. I acknowledge that this declaration is made voluntarily and without any coercion.
6. I understand the legal implications of making false statements and am aware that providing false information may lead to legal consequences.
7. I declare that I have not been convicted of any criminal offense, and there are no legal proceedings against me.

I make this declaration to affirm the accuracy of the information provided above for [mention the purpose, if applicable].

If required, I am willing to provide supporting documents or undergo verification to validate the information provided in this declaration.

Thank you for your understanding and consideration.

Sincerely,

[Your Full Name]
[Your Signature – if sending a hard copy]

Subject: Self-Declaration Letter Request

Dear [Recipient’s Name],

I hope this email finds you well. I am writing to request a self-declaration letter for [Reason for the letter]. I need this letter for [Purpose of the letter]. I understand that this letter is a written statement in which I declare certain facts and confirm them to be true to the best of my knowledge.

As per your requirements, I am enclosing all the necessary documents and information to support my declaration. I have carefully reviewed the information provided and confirm that it is accurate and true to the best of my knowledge.

I would appreciate it if you could kindly provide me with the format for the self-declaration letter. I will be happy to draft the letter myself and submit it for your review and approval. Please let me know if you require any further information or documents from me.

Thank you for your prompt attention to this matter. I look forward to hearing from you soon.

Sincerely,

[Your Name]
[Your Contact Information]

[Your Full Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Date]

[Recipient’s Name or Designation, if applicable]
[Company or Organization Name, if applicable]
[Address, if applicable]
[City, State, ZIP Code]

Subject: Self-Declaration Letter for Health Reasons

Dear [Recipient’s Name or Sir/Madam],

I, [Your Full Name], residing at [Your Address], hereby declare the following information related to my health:

1. I declare that I am aware of my health condition and provide this declaration voluntarily.
2. I affirm that I am currently experiencing [mention the health issue or symptoms], which requires attention and possible medical intervention.
3. I understand the importance of seeking medical advice and am committed to following any prescribed treatment or recommendations for my health.
4. I acknowledge that this declaration is made for the purpose of informing [Recipient’s Name or relevant authority] about my current health status.
5. I declare that I am taking necessary precautions to prevent the spread of any contagious illness and am adhering to relevant health guidelines.
6. I understand the potential impact of my health condition on my ability to perform regular duties or activities, and I am taking the necessary steps to manage it effectively.

If required, I am willing to provide supporting medical documents or undergo a medical examination to validate the information provided in this declaration.

I appreciate your understanding and cooperation in this matter. If you have any specific procedures or forms related to health declarations, please guide me accordingly.

Thank you for your attention to this matter.

Sincerely,

[Your Full Name]
[Your Signature – if sending a hard copy]

[Your Full Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Date]

[Recipient’s Name or Designation, if applicable]
[Company or Organization Name, if applicable]
[Address, if applicable]
[City, State, ZIP Code]

Subject: Self-Declaration Letter for Medical Purposes

Dear [Recipient’s Name or Sir/Madam],

I, [Your Full Name], residing at [Your Address], hereby declare the following information related to my medical condition for the purpose of [mention the specific medical purpose]:

1. I declare that the information provided in this letter is true and accurate to the best of my knowledge.
2. I affirm that I am currently undergoing medical treatment for [mention the medical condition] under the supervision of [mention the healthcare professional’s name].
3. I acknowledge that my medical condition may require occasional leaves or adjustments in my schedule to attend medical appointments and follow-up treatments.
4. I am committed to adhering to the prescribed medical treatment plan and will take all necessary measures to ensure a speedy recovery.
5. I understand the importance of keeping [Recipient’s Name or relevant authority] informed about my medical condition, and I am open to providing any additional information or documentation if required.

If necessary, I am willing to provide supporting medical documents or undergo a medical examination to validate the information provided in this declaration.

I appreciate your understanding and support in this matter. If there are any specific procedures or forms related to medical declarations, please guide me accordingly.

Thank you for your consideration.

Sincerely,

[Your Full Name]
[Your Signature – if sending a hard copy]

[Your Name]
[Your Address]
[City, State, Zip Code]
[Phone Number]
[Email Address]

[Date]

To Whom It May Concern,

I, [Your Name], hereby declare that the address provided above is my current and permanent address. I am currently residing at the above-mentioned address and have been living here since [Date/Month/Year].

I am writing this letter to use it as proof of my address for [reason for address proof]. I confirm that the information provided in this letter is true and accurate to the best of my knowledge.

I understand that any false or misleading information provided in this letter may result in legal action being taken against me. I am solely responsible for the accuracy of the information provided in this letter.

Please find attached a copy of my [ID proof/Utility Bill] for your reference.

Thank you for your attention to this matter.

Sincerely,

[Your Signature]
[Your Name]

[Your Name]
[Your Address]
[City, State, Zip Code]
[Phone Number]
[Email Address]

[Date]

To Whom It May Concern,

I, [Your Name], hereby declare that I have earned an income of [Amount] during the financial year [Date/Month/Year]. The source of my income is from [Employment/Business/Other source].

I am writing this letter to declare my income for the purpose of filing my income tax return. I confirm that the information provided in this letter is true and accurate to the best of my knowledge.

I understand that any false or misleading information provided in this letter may result in legal action being taken against me. I am solely responsible for the accuracy of the information provided in this letter.

Please find attached the necessary supporting documents, including my [Salary/Bank Statements/Form 16/Other Income Documents].

Thank you for your attention to this matter.

Sincerely,

[Your Signature]
[Your Name]

Sample 3: Self-Declaration Letter for Medical Leave

[Your Name]
[Your Address]
[City, State, Zip Code]
[Phone Number]
[Email Address]

[Date]

To Whom It May Concern,

I, [Your Name], hereby declare that I am suffering from [Medical Condition] and require medical leave from [Date/Month/Year] to [Date/Month/Year]. My medical condition prevents me from performing my regular duties and responsibilities at work.

I am writing this letter to declare my medical condition and request leave from work. I confirm that the information provided in this letter is true and accurate to the best of my knowledge.

I understand that any false or misleading information provided in this letter may result in disciplinary action being taken against me. I am solely responsible for the accuracy of the information provided in this letter.

Please find attached a copy of my medical certificate issued by my doctor, which states the duration of my medical leave.

Thank you for your attention to this matter.

Sincerely,

[Your Signature]
[Your Name]

[Your Name]
[Your Address]
[City, State, Zip Code]
[Phone Number]
[Email Address]

[Date]

To Whom It May Concern,

I, [Your Name], hereby declare that I am suffering from [Medical Condition] and require medical leave from [Date/Month/Year] to [Date/Month/Year]. My medical condition prevents me from performing my regular duties and responsibilities at work.

I am writing this letter to declare my medical condition and request leave from work. I confirm that the information provided in this letter is true and accurate to the best of my knowledge.

I understand that any false or misleading information provided in this letter may result in disciplinary action being taken against me. I am solely responsible for the accuracy of the information provided in this letter.

Please find attached a copy of my medical certificate issued by my doctor, which states the duration of my medical leave.

Thank you for your attention to this matter.

Sincerely,

[Your Signature]

[Your Name]

[Your Full Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Date]

[Recipient’s Name or Designation, if applicable]
[Company or Organization Name, if applicable]
[Address, if applicable]
[City, State, ZIP Code]

Subject: Self-Declaration Letter for Travel

Dear [Recipient’s Name or Sir/Madam],

I, [Your Full Name], residing at [Your Address], hereby declare the following information for the purpose of travel:

1. I declare that the information provided in this letter is accurate and true to the best of my knowledge.
2. I am undertaking travel from [departure location] to [destination location] on [date of travel].
3. The purpose of my travel is [briefly mention the reason for travel, such as personal, business, family visit, etc.].
4. I am aware of the current travel restrictions, health and safety guidelines, and any quarantine requirements at the destination.
5. I commit to following all applicable health protocols during my travel, including wearing masks, practicing social distancing, and adhering to any other guidelines provided by health authorities.
6. I understand the risks associated with travel during the ongoing [mention any pandemic or health crisis], and I will take necessary precautions to minimize any potential impact.
7. If required, I am willing to undergo any medical screenings or testing as mandated by the relevant authorities.

I appreciate your understanding and support in this matter. If there are any specific procedures or forms related to travel declarations, please guide me accordingly.

Thank you for your consideration.

Sincerely,

[Your Full Name]
[Your Signature – if sending a hard copy]

[Your Full Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Date]

[Recipient’s Name or Designation, if applicable]
[Company or Organization Name, if applicable]
[Address, if applicable]
[City, State, ZIP Code]

Subject: Self-Declaration Letter

Dear [Recipient’s Name or Sir/Madam],

I, [Your Full Name], residing at [Your Address], hereby declare the following information:

1. I declare that the information provided in this letter is true and accurate to the best of my knowledge.
2. I am currently employed/self-employed at [Your Employer’s Name or Business Name], located at [Company Address], in the position of [Your Designation or Occupation].
3. I confirm that I am a citizen of [Your Nationality].
4. I declare that I have not been convicted of any criminal offense, and there are no ongoing legal proceedings against me.
5. This declaration is made voluntarily and without any coercion.

I make this declaration to affirm the accuracy of the information provided above for [mention the purpose, if applicable].

If required, I am willing to provide supporting documents or undergo verification to validate the information provided in this declaration.

I appreciate your understanding and cooperation in this matter. If there are any specific procedures or forms related to this declaration, please guide me accordingly.

Thank you for your attention to this matter.

Sincerely,

[Your Full Name]
[Your Signature – if sending a hard copy]

[Your Full Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Date]

[Healthcare Provider’s Name or Designation, if applicable]
[Healthcare Facility Name, if applicable]
[Address, if applicable]
[City, State, ZIP Code]

Subject: Self-Declaration Letter for Health Check-up

Dear [Healthcare Provider’s Name or Sir/Madam],

I, [Your Full Name], residing at [Your Address], hereby declare the following information for the purpose of a health check-up:

1. I declare that the information provided in this letter is true and accurate to the best of my knowledge.
2. I am currently seeking a health check-up at [Healthcare Facility Name], under the supervision of [Healthcare Provider’s Name].
3. The purpose of this health check-up is [briefly mention the reason for the health check-up, such as routine examination, preventive care, etc.].
4. I am committed to following all recommended health protocols and instructions provided by the healthcare professionals during the check-up.
5. I understand the importance of disclosing accurate medical history and information for a thorough evaluation.
6. If required, I am willing to provide additional information, undergo further tests, or follow any prescribed treatments based on the results of the health check-up.

I appreciate your attention to this matter and assure you of my cooperation throughout the health check-up process.

Thank you for your understanding and support.

Sincerely,

[Your Full Name]
[Your Signature – if sending a hard copy]

[Your Full Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Date]

[Recipient’s Name or Designation, if applicable]
[Company or Organization Name, if applicable]
[Address, if applicable]
[City, State, ZIP Code]

Subject: Self-Declaration Letter for COVID-19 Symptoms

Dear [Recipient’s Name or Sir/Madam],

I, [Your Full Name], residing at [Your Address], hereby declare the following information regarding COVID-19 symptoms:

1. I declare that the information provided in this letter is true and accurate to the best of my knowledge.
2. I am currently experiencing symptoms associated with COVID-19, including [mention specific symptoms, such as fever, cough, shortness of breath, etc.].
3. I understand the importance of promptly notifying [Recipient’s Name or relevant authority] about my symptoms to ensure the safety and well-being of others.
4. I am committed to following all recommended health protocols, including self-isolation and seeking medical advice for testing and treatment.
5. I will inform [Recipient’s Name or relevant authority] immediately of any updates regarding my health status and adhere to any guidance provided.
6. If required, I am willing to provide additional information, undergo COVID-19 testing, or follow any prescribed measures recommended by healthcare professionals.

I appreciate your understanding and cooperation in this matter. If there are any specific procedures or forms related to COVID-19 symptom declarations, please guide me accordingly.

Thank you for your attention to this matter.

Sincerely,

[Your Full Name]
[Your Signature – if sending a hard copy]