Affidavit Of Unmarried Form - Couples

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Affidavit of Unmarried – Couples
I the undersigned _____________________ holder of Identity Card ________________ (the
Student)
And - _____________________ holder of Identity Card ___________________________
After being warned that we must state the truth or be liable to penalties under law, hereby declare
as follows:
1. We manage a joint household and for all intents and purposes live as a couple.
2. Commencing from _______________ (mandatory to complete) we share a joint apartment.
(* at least 7 months before the date of signing on this Affidavit). Presently, the address
of our joint residence is _______________________.
3. If approval for living in a dormitory granted, I will live in the apartment that has been approved
with my partner who has declared on the application for dormitories and this affidavit.
4. Should we split up, we are aware that we are required to inform the scholarship and housing
department at the Graduate School (MSc and PhD students) / the main dormitories office
(undergraduate students) in writing immediately, and we would be requested to leave our
apartment in the dormitories without any commitment to receive other living quarters in the
dormitories.
5. We are aware that the Technion relies on our declarations and on the basis thereof see us
as a couple and if it becomes apparent that our declarations are untrue and/or incomplete or
inaccurate, this would be sufficient to cancel the rights that we received from the Technion
and would likely to be regarded as a disciplinary violation and compel the payment of agreed
compensation for a false statement.
These are our names, our signatures and the contents of the affidavit are true.
Signature: _______________
Signature: _________________
Date: ____________
 To attach a copy of the Identity Cards including the addendums of the couple.
Lawyer's Confirmation
I ________________ Lawyer, hereby confirm that _______________ [name of the student] and -
___________________ [name of partner], identified by Identity Card number ______________ and
number _______________, respectively, appeared before me on the ______ day of the month
__________ year ______ and after being cautioned that any failure to declare the truth will be
punishable by law, signed the above Affidavit.
Lawyer's Signature and Stamp _________________

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