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Self - Declared Affidavit Is Not Accepted. 2. All Blanks To Be Duly Filled

This document provides an affidavit format for obtaining a death certificate. It includes blanks for the applicant and deceased's personal details. The applicant must declare their relationship to the deceased, the date and place of death, and the deceased's Aadhar number if they had one. The applicant signs declaring the statements are true, and the magistrate authenticates the affidavit.

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105 views

Self - Declared Affidavit Is Not Accepted. 2. All Blanks To Be Duly Filled

This document provides an affidavit format for obtaining a death certificate. It includes blanks for the applicant and deceased's personal details. The applicant must declare their relationship to the deceased, the date and place of death, and the deceased's Aadhar number if they had one. The applicant signs declaring the statements are true, and the magistrate authenticates the affidavit.

Uploaded by

patel viren
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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AFFIDAVIT FORMAT TO OBTAIN DEATH CERTIFICATE

Note:

1. Self – declared affidavit is not accepted.


2. All blanks to be duly filled.

IN THE COURT OF EXECUTIVE MAGISTRATE: ITANAGAR/NAHARLAGUN/BANDERDEWA

PAPUM PARE DISTRICT: ARUNACHAL PRADESH


AFFIDAVIT
I Shri/Smt. (APPLICANT NAME), son/daughter/wife of Shri (APPLICANT’S FATHER/HUSBAND
NAME), Permanent resident of village (VILLAGE/TOWN), PO- (POST OFFICE), PS- (POLICE STATION),
Distt.- (District), State of (State) and presently residing at ward No- (Ward No.), Sector / Village-
(Sector/Village), Po- (POST OFFICE) , Ps-(POLICE STATION),, Distt.- (District), State -(State), do hereby
declare as follows:

1. That Late (NAME OF THE DECEASED) was my (RELATION OF DECEASED TO APPLICANT).


2. That his/her date of death was on (DATE OF DEATH (dd/mm/yyyy).
3. That (NAME OF DECEASED) possesses Aadhar and its number is (AADHAR NUMBER OF
DECEASED/ APPLICANTS AADHAR NO. INCASE DECEASED DOESN’T POSSESS AADHAR).
4. That his/her place of death was at (PLACE OF DEATH).
5. That this affidavit is sworn into obtain death Certificate from the competent authority.
DECLARATION
I Shri/Smt. (APPLICANT’S NAME) declare that the above statements from Para 1 to 5 are true to
the best of my knowledge and belief, if any false declaration, I shall be liable to punishment as per the
provision of Aadhar Act, 2016 and also the registration of Birth & Death Act, 1969.

DEPONENT

Executed and signed before me by Shri/Smt.…………………………………………. in my court on this………day


of………………….20__. (ALL BLANKS IN THIS SECTION TO BE FILLED BY THE MAGISTRATE)

EXECUTIVE MAGISTRATE

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