A.
According to DGR 59th Edition, DGR 8.1.6.13 Note spells: “The title of the person signing the declaration is optional and may be left blank.” DGR 8.1.6.14 Notes 1. also spells: “The Place of signing the declaration is optional and maybe left blank.” Consequently, you may leave both the Title of Signatory as well as the Place of signing blank.

Effective 1 January 2019 with the 60th Edition DGR, both the “Title of Signatory” and the “Place of signing” are to be removed from the requirement.