Affidavit for Issuance of Death Certificate: Format
Reference draft used in Indian courts — replace the blanks with your own case details.
Precedent No. 83
AFFIDAVIT: ISSUANCE OF DEATH CERTIFICATE
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
Residing 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.
Using this format
This is a reference draft reproduced for study and adaptation. Court rules, court fees and the correct forum vary with the facts and the value of the claim, so have the document checked and filed by an advocate. A defective application can be returned or dismissed even when the case itself is good.
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Disclaimer: this page is a sample format reproduced for reference and study. It is not legal advice and does not create an advocate–client relationship.