Affidavit

I Smt. Geeta w/o Late Sh. Ishwar R/o – H No. 9, Fatehpur Beri, New Delhi 110074 do hereby solemnly
affirm and declare as under:-

1. That Sh. Ishwar S/o Late Sh. Ragbir expired at our residence in Village Fatehpur Beri, New Delhi
on 04-05-2021 and death was registered with MCD. Death Certificate No. MCDOLIR-0221-
121782 dated 26-05-2021 is attached.

2. That after the death of my husband Sh. Ishwar, the following are the survival members in the
family.

S No. Name Age Relationship with deceased

1. Dropdi 78 Mother
2. Geeta 39 Wife
3. Bobby 22 Son
4. Rinki 20 Daughter
5. Sakshi 18 Daughter
6. Shivani 16 Daughter (Minor)

3. That the none other than mentioned above is the survival member in the family.
4. That I am Indian citizen.
5. That survival member certificate is required for the purpose of bonafide need.
6. That this is my true statement.

Deponent

Verification:

Verified at Delhi, this _____________ day of November 2021 that the contents of the affidavit are true
& correct to the best of my knowledge and belief and nothing has been concealed therein.

Deponent
 Affidavit
I Smt. Dropdi w/o Late Sh. Ragbir Singh R/o – H No. 9, Fatehpur Beri, New Delhi 110074 do hereby
solemnly affirm and declare as under:-

1. That Sh. Ishwar S/o Late Sh. Ragbir expired at our residence in Village Fatehpur Beri, New Delhi
on 04-05-2021 and death was registered with MCD. Death Certificate No. MCDOLIR-0221-
121782 dated 26-05-2021 is attached.

2. That after the death of my husband Sh. Ishwar, the following are the survival members in the
family.

S No. Name Age Relationship with deceased

7. Dropdi 78 Mother
8. Geeta 39 Wife
9. Bobby 22 Son
10. Rinki 20 Daughter
11. Sakshi 18 Daughter
12. Shivani 16 Daughter (Minor)

3. That the none other than mentioned above is the survival member in the family.
4. That I am Indian citizen.
5. That survival member certificate is required for the purpose of bonafide need.
6. That this is my true statement.

Deponent

Verification:

Verified at Delhi, this _____________ day of November 2021 that the contents of the affidavit are true
& correct to the best of my knowledge and belief and nothing has been concealed therein.

Deponent
 Affidavit
I Smt. Bobby S/o Late Sh. Ishwar R/o – H No. 9, Fatehpur Beri, New Delhi 110074 do hereby solemnly
affirm and declare as under:-

1. That Sh. Ishwar S/o Late Sh. Ragbir expired at our residence in Village Fatehpur Beri, New Delhi
on 04-05-2021 and death was registered with MCD. Death Certificate No. MCDOLIR-0221-
121782 dated 26-05-2021 is attached.

2. That after the death of my husband Sh. Ishwar, the following are the survival members in the
family.

S No. Name Age Relationship with deceased

13. Dropdi 78 Mother
14. Geeta 39 Wife
15. Bobby 22 Son
16. Rinki 20 Daughter
17. Sakshi 18 Daughter
18. Shivani 16 Daughter (Minor)

3. That the none other than mentioned above is the survival member in the family.
4. That I am Indian citizen.
5. That survival member certificate is required for the purpose of bonafide need.
6. That this is my true statement.

Deponent

Verification:

Verified at Delhi, this _____________ day of November 2021 that the contents of the affidavit are true
& correct to the best of my knowledge and belief and nothing has been concealed therein.

Deponent
 Affidavit
I Smt. Rinki D/o Late Sh. Ishwar R/o – H No. 9, Fatehpur Beri, New Delhi 110074 do hereby solemnly
affirm and declare as under:-

1. That Sh. Ishwar S/o Late Sh. Ragbir expired at our residence in Village Fatehpur Beri, New Delhi
on 04-05-2021 and death was registered with MCD. Death Certificate No. MCDOLIR-0221-
121782 dated 26-05-2021 is attached.

2. That after the death of my husband Sh. Ishwar, the following are the survival members in the
family.

S No. Name Age Relationship with deceased

19. Dropdi 78 Mother
20. Geeta 39 Wife
21. Bobby 22 Son
22. Rinki 20 Daughter
23. Sakshi 18 Daughter
24. Shivani 16 Daughter (Minor)

3. That the none other than mentioned above is the survival member in the family.
4. That I am Indian citizen.
5. That survival member certificate is required for the purpose of bonafide need.
6. That this is my true statement.

Deponent

Verification:

Verified at Delhi, this _____________ day of November 2021 that the contents of the affidavit are true
& correct to the best of my knowledge and belief and nothing has been concealed therein.

Deponent
 Affidavit
I Smt. Sakshi Tanwar w/o Late Sh. Ishwar R/o – H No. 9, Fatehpur Beri, New Delhi 110074 do hereby
solemnly affirm and declare as under:-

1. That Sh. Ishwar S/o Late Sh. Ragbir expired at our residence in Village Fatehpur Beri, New Delhi
on 04-05-2021 and death was registered with MCD. Death Certificate No. MCDOLIR-0221-
121782 dated 26-05-2021 is attached.

2. That after the death of my husband Sh. Ishwar, the following are the survival members in the
family.

S No. Name Age Relationship with deceased

25. Dropdi 78 Mother
26. Geeta 39 Wife
27. Bobby 22 Son
28. Rinki 20 Daughter
29. Sakshi 18 Daughter
30. Shivani 16 Daughter (Minor)

3. That the none other than mentioned above is the survival member in the family.
4. That I am Indian citizen.
5. That survival member certificate is required for the purpose of bonafide need.
6. That this is my true statement.

Deponent

Verification:

Verified at Delhi, this _____________ day of November 2021 that the contents of the affidavit are true
& correct to the best of my knowledge and belief and nothing has been concealed therein.
Deponent