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Affidavit Format for Obtaining Death Certificate of the Deceased

When you are making an application for the issue of the death certificate of someone, the concerned government authority may require an affidavit from you along with other supporting documents.

affidavit format for obtaining death certificate
An affidavit specifying name of the deceased, date and location of death and name of the deponent is a written statement by legal heir(s) declaring and confirming the death details of the deceased.

The affidavit can be used as evidence in the court of law, in case the matter is disputed and a suit is filed in court. Hence, you need to ensure all the statements mentioned in the affidavit are true.

Here is an affidavit format for obtaining a death certificate.

TEMPLATE

IN THE COURT OF EXECUTIVE MAGISTRATE: _______
_________ DISTRICT: (Name of the State)

AFFIDAVIT

I, Shri/Smt. (Name of the Applicant), son/daughter/wife of Shri (Name of the Father/Husband), permanent resident of (Name of the Village) village, P.O. _________, P.S. (Police Station Name), Dist. (District Name), State of _________ and presently residing at ward no. ___, (Name of the Village) village, P.O. _________, P.S. (Police Station Name), Dist. (District Name), State of _________, do hereby solemnly affirm and declare as under:

1. That Late (Name of the Deceased), son/daughter/wife of Shri (Name of the Father/Husband), expired on (Date).
2. That his/her place of death was at (Location).
3. That Late (Name of the Deceased) was my (Relation of the Deceased to the Applicant).
4. That (Name of the Deceased) was issued Aadhar in his/her name and its number is _________.
5. That the above said death was not registered in the Death Register of the records of _________ Panchayat / Municipal in the District of _________.
6. That no death certificate for Late (Name of the Deceased) has been obtained from any authority in India.
7. That this affidavit is sworn into in order to obtain the Death Certificate from the competent authority.

Declared at (Place) on this _____day, ___th of (Month), (Year).

(Signature) 
DEPONENT

VERIFICATION

I, Shri/Smt. (Name of the Applicant) declare that the statements from Para 1 to 7 in the above-mentioned affidavit are true to the best of my knowledge and belief and that nothing material has been concealed therefrom. I am aware that in case the information furnished above is found to be incorrect, I shall be liable for prosecution under the relevant law for the time being in force.

Verified at (Place) on this _____day, ___th of (Month), (Year).

(Signature) 
DEPONENT


Executed and signed before me by Shri/Smt. __________________ in my court on this ___th day of (Month), (Year).

(Signature)
EXECUTIVE MAGISTRATE


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