Form 206

Evidence of Life

Evidence of Life In the _______________ Division of the High Court

Declaration of person ____________________________ District Registry

entitled to payment
Please use BLOCK CAPITALS A/c No.
Full Account
Title

To the Accountant General, Court Funds Office, 22 Kingsway, London WC2B 6LE
I _____________________________________________________________________________________

of ____________________________________________________________________________________
_______________________________________________________________________________________
Fo
declare that I was living on _______________________ 19 ___
(Tick and complete if appropriate)

Either
Insert full
and that
names of,
e.g. patent,
minor or
minors
named in the Order dated _______________________ 19 was/were then
Cross out
words not alive and was/were under the age of 18 years/a patient.
applicable or
and I was then
Complete, if
of
applicable,
by inserting
Minister or
Treasurer etc.
Signed
This declaration should be witnessed by (Signature of person entitled to payment)
•
a person who knows the declarant Declared before me on the _________________________________19 ___
personally and who is a Member of
Parliament, Minister of Religion, Doctor,
Signed
Lawyer, Bank Manager or a person of
(Signature of witness)
similar standing.
Address ________________________________________________________

• This declaration should not be witnessed

by a relative of the declarant.

Qualification ______________________________________________________

Court Funds Rule 40.