Free affidavit of death 33
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Format of Affidavit for
Death Benefit Claim
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

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 ____________