XIV.

Affidavit for obtaining death certificate

I _______________ S/o __________________ R/o ___________ do hereby
solemnly affirm and declare as under:
(1) That Shri __________________ expired on ___________
(2) That the deceased is my ____________________________.
(3) That due to inadvertence, I did not register the date of death of Late
Shri __________________ with the concerned department.
(4) That it is my true statement.
Deponent
Verification
Verified on _________________ at ______________ that the contents of the
affidavit are true & correct to the best of my knowledge and belief and nothing
has been concealed therein.
Deponent