I, , aged years, son/daughter/spouse of , residing at , do hereby solemnly affirm and declare as follows:
| S. No. | Name | Relationship | Age |
|---|---|---|---|
| 1 | |||
| 2 | |||
| 3 |
3. That among the above-mentioned legal heirs, there is no other legal heir existing as per my knowledge and belief.
4. I affirm that the information given hereinabove is true and correct to the best of my knowledge and belief and nothing material has been concealed therefrom.
Verified at on this day of . The above-stated facts are true and correct to the best of my knowledge and belief.