Statement of residence history — sworn template
This statement sets out, under oath, the sequence of places where you have lived over a given period — addresses, cities, countries, with the start and end dates of each period, including any gaps.
It is often requested for a citizenship or permanent residence application, a security check, or a background check, when a residential history must be reconstructed that no single document proves.
What is this template for?
It formally records, under oath, the chronology of the declarant's successive residences over a specific period, for an organization.
When can it be used?
- Reconstructing a residence history for a citizenship or permanent residence application
- Supporting a background check that requires the list of past addresses
- Completing a file when some periods of residence cannot be proven with documents
Before using it
If the receiving organization provides a form or a table to complete for residence history (common in immigration), that official form must be used first.
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Important notice
This template is provided for informational purposes only. It is not an official government form, nor legal advice. Check the exact format the recipient expects before using this template, and provide any supporting documents you have.