I, ___________wife of late __________resident of  ________, Tehsil & District _________, 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 Name) Bank, ___________ (Account Details)

3.    That he left behind the following legal heirs :-

(1) _________(2) ________ (if any) all sons/daughters of late ____________son of _________& (3) ___________ wife of late _________________ all resident of ___________, Tehsil & Distt._______________,

4.    That the  deceased have no children of my aforesaid expect the mentioned above

DEPONENT

VERIFICATION:-

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 ____________

DEPONENT