AFFIDAVIT

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 _________.

Deponent

VERIFICATION

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 _________.

Deponent