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
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 ____________