I [name of declarant] of [address of declarant], hereby declare that on [date of resignation] I resigned from [state nature of office, etc.] and that I would not have resigned but for my opposition to the promulgation of the Canon of the Church of England enabling a woman to be ordained to the office of priest.
[signature of declarant]
[date]
Signed and dated in the presence of
[name of witness] of [address of witness]
[signature of witness]