APPLICATION FORM FOR SUCCESSION CERTIFICATE.

[Death certificate of deceased and 3 (Three) Nos. Passport size photographs of the applicant to be attached
with this application.]

1. Name of deceased: ……………………………………………………

2. Father’s/ Husband’s Name: ……………………………………………………
3. Permanent home address:
Village- …………………………………………………..
PO- …………………………………………………..
PS- ………………………………………………….
Dist- ………………………………………………….
State- ………………………………………………….
4. Name of applicant: …………………………………………………
5. Relation with deceased. : …………………………………………………
6. Present address :
Village- …………………………………………………
PO- …………………………………………………
PS- …………………………………………………
Dist- …………………………………………………
State- …………………………………………………
7. Details of debts applied for.
Sl. Details of debts Name & Address of debtor Amount Remarks
No.
1

8. Name and address of family members. ……………………………………………

……………………………………………
……………………………………………
……………………………………………
9. Name & Address of relatives of deceased. ………………………………………….
……………………………………………
……………………………………………
……………………………………………

Certified that the information furnished above is true to the

best of my knowledge and belief.

Signature of applicant with date.