LEGAL HEIR CERTIFICATE

Having fully satisfied myself with the right and title of the claimant(s) I recommended that the
amount due to be paid to late Mr./Mrs._____________________ with respect to ………….
may be paid to the person(s) mentioned below who are the only rightful heirs of the
deceased employee.

Relationship with Demised person

Signature Head of the Department/Office

d: _____________ Department of _________________