Affidavit for Death Benefit Claim

AFFIDAVIT

I, ___________ wife of late __________ Resident of ________, Tehsil & Distt_________, do hereby solemnly affirm and declare as under:-
1. That Late __________is my husband who expired on dated ________ (Death certificate enclosed).
2. That he had the following  account with __________ Bank, _____________vide
3. That he left behind the following legal heirs :-
(1) _________(2) ________(3) ___________(4) ________all sons/daughters of late ____________son of _________ & (5) ___________ Wife of late _________________ All resident of___________, Tehsil & Distt._______________,
4. That the  deceased have no children of my aforesaid expect the mentioned above

DEPONENT

VERIFICATION:-
Verified that the contents of the above said affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.
Verified at ___________ on  this ____________

DEPONENT

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