I, Smt. _________ widow of Late _________, resident of _________ , do hereby solemnly affirm and declare as under:-
1- That I am legally wedded wife of the above named deceased pensioner I have not remarried since the demise of my late husband.
2- That I am not in the receipt of any other family pension from any other source.
3- That my correct date of birth / age is _________ years.
4- That I am fully entitled to get the Widow pension from the _________.
Verified that the contents of my above affidavit are true and correct to best of my knowledge and belief and nothing has been concealed therein.
Verified at _________ on _________.