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Student Finance, parents separated. Statutory Declaration, help!

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Hi guys, I am in the very late stages of completing my student finance application and need to send in the last few bits.

My parents have separated and I need proof of this to supply to Student Finance England, in the form of a Statutory Declaration however due to certain circumstance we are not willing to fork out in excess of £100 for a couple of lines typed up by a solicitor.

My dad has an appointment with a solicitor on monday to get the declaration sworn by but this has meant we have to type up our own declaration, I have done this but have been stumped by the addresses I need to put. Will i need to put my mums current address anywhere in here?

Below is where I am at:

'Statutory Declaration

I, (father name) of (fathers current address) do solemnly and sincerely declare as follows:

I was married to (wife name) of (which address do I put here?) on 12/03/93.

I have been separated from (wife name) of (which address do i put here?) since 29/12/12 and she has not lived at the matrimonial home since that date.

I make this solemn declaration believing the same to be true and by virtue of the Statutory Declarations Act 1835.

Signed:

Declared at:

on the Monday day of August 2013, 12/08/13,

before me:'

Furthermore would this be sufficient enough for a solicitor to sign and be accepted by Student Finance England as proof of my father's now separated marital status? Any help would be much appreciated and any further additions or indeed improvements.

Thanks in advance :)
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