õ£ó¤²ó¤¬ñê¢ ê£ù¢ø¤î¿è¢è£ù õ¤í¢íð¢ðð¢ ð®õñ¢

APPLICATION FORM FOR LEGALHEIRSHIP CERTIFICATE

1. õ¤í¢íð¢ðî£óó¤ù¢ ªðòó¢
Name of the Applicant:

2. îèð¢ðù£ó¢ / èíõó¢ ªðòó¢

Father/Husband’s Name:

3. Ýí¢ / ªðí¢
Sex (M/F) :

4. Þ¼ð¢ð¤ì ºèõó¤
Residential Address :

5. Þøï¢îõó¤ù¢ ªðòó¢
Name of the deceased :

6. Þøð¢¹ê¢ ê£ù¢ø¤îö¢ âí¢.

(Íôê¢ ê£ù¢ø¤îö¢ Þ¬íè¢èð¢ðì «õí¢´ñ¢)
Death Certificate No. :
(Original Certificate to be enclosed)

7. Þøï¢îõó¤ù¢ õ£ó¤²è÷¢ õ¤õóñ¢

Legal Heirs of the deceased *
õó¤¬ê ªðòó¢ õò¶ àø¾ º¬ø ñíñ£õó¢ /
âí¢. Name Age Relationship ñíñ£è£îõó¢
Sl.No. Marital Status
(1) (2) (3) (4) (5)

• ñÂî£óó¢ Þú¢ô£ñ¤ò ñîîê¢ «êó¢ï¢îõªóù¤ô¢ Þú¢ô£ñ¤ò êì¢ì

õ¤î¤è÷¤ù¢ð® õ£ó¤²î£óó¢è÷¢ õ¤õóñ¢
• If the applicant belongs to Islam Religion, the details of the
legalheirs of the deceased as per Islamic Rules may be given.
8. âù¢ù è£óíî¢î¤ø¢è£è ê£ù¢ø¤îö¢
«î¬õð¢ð´è¤ø¶?
(«î¬õò£ù Ýõíî¢î¤ù¢ ¡
ïèô¢™êñó¢ð¢ð¤è¢è «õí¢´ñ¢)
Purpose for which the certificate is required.
(Necessary documents to be enclosed)

Ü) Þøï¢îõó¢ å¼ ñíî£óó£? Þ¼ ñíî£óó£?

(ºîô¢ ñ¬ùõ¤ò¤ù¢ °öîè÷¢ /
Þóí¢ì£õ¶ ñ¬ùõ¤ò¤ù¢ °öîè÷¢
õ¤õóñ¢ Þ¬íè¢èð¢ðì «õí¢´ñ¢)

Deceased had one wife/ two wives

(Details of children of first wife /
Second wife to be enclosed)

Ý) õ¤õóé¢è÷¢
Details

9. °´ñ¢ð Ü좬ì âí¢.

Ration Card No.

10. ñÂî£óó¢˜ Þøï¢îõ¼è¢° âï¢î õ¬èò¤ô¢™ àø¾?

Relationship of the petitioner with the deceased.

11. õ¤í¢íð¢ð ï£÷¢

Date of application :

õ¤í¢íð¢ðî£óó¤ù¢ ¬èªò£ð¢ðñ¢
Signature of the Applicant