BEFORE THE REGISTRAR OF BIRTHS AND DEATHS,

Affidavit in an Application for a certificate for Registration No
of, 20

AFFIDAVIT of ,

S/o ,

Aged …………………. years

esiding in ………………………………

The deponent abovenamed hereby solemnly affirms and states as follows:—

My mother died a peaceful and natural death on

I have already applied for the Certificate of Administration of the estate left behind by my deceased mother as I am her only surviving legal representative.

For the purpose of issuing the aforesaid certificate, the Administrator-General of has directed the production of a certificate of
death of my deceased mother from the competent authority.

The death of my mother has been duly notified to the Registrar.

It is, therefore, just and necessary that the Registrar may be pleased to issue a Death Certificate in respect of my mother’s death, so that I can produce the same before the aforesaid Administrator-General to obtain the certificate of Administration.

Sd./ Deponent.
Verification

Verified at on this the day of , 20

that the contents of the above affidavit are true and correct to the best of my knowledge,

elief and information and nothing material has been concealed therefrom.

Sd./ Deponent.
Solemnly affirmed and signed before me by the deponent, who is personally
known to me, on this the day of ,20
Sd./ Notary.