Form 76-Affidavit of Death

Form 76-Affidavit of Death

Form 76.

O.19, rr.24,25,26

AFFIDAVIT OF DEATH

(As to heading, see O.19, r.3.)

On . . . , 20..., I . . . (name, address and occupation) . . . say on oath-

1. I was well acquainted with . . . (name of deceased) late of . . . (place). . . (occupation) for . . . (number) years.

2. I saw his dead body on the day he died, that is to say, on . . . (date).

3. I am not interested in his estate.

or in lieu of Paragraphs 2 and 3

2. I believe that he is . . . (name in certificate of registration of death) referred to in the certificate of registration of death which is annexed and marked A .

Sworn at }

before me }