I, _____ wife of late _____ R/o _____, 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) _____ all sons/daughters of late _____ son of _____ & (3) _____ Wife of late _____ All resident of _____,
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 _____