Sample format
On Rs.10/- Non Judicial Stamp
Before the Notary Public at Jalpaiguri
A F F I D A V I T
I , Smt./Sri XXXX, D/o, Late XXXX (father) and Late XXXX (mother) and wife of Sri XXX ,by Religion Hindu, residing at XXXXXX, Police Station XXXX, , Po & Dist. XXXX, Presently residing at XXXXX Road, XXXXX, do hereby solemnly affirm and affidavit as follows:
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Page-2
That I am a citizen of India and a Residents of afore said address. I am holding PAN: XXXXXXX and Aadhaar No:XXXXXX
That Late XXXXXXX was my Mother (PAN: XXXXXX)
That my Mother Late XXXXXX died on XX-XX-XXXX at her residence at XXXXX Police Station , XXXX, Post Office & District XXXXX
That at the time of death of my Mother Late XXXXXX, she left behind following persons as her only legal Heirs:
Sl No
Name of the Heir
Relationship with the Deceased
1
XXXXXX
W/o
Married Daughter
2
XXXXXXX
W/o,
Married Daughter
That there are no other Legal Heir and / or Legal Heirs of Late XXXXXXX except the Names as mentioned in Clause 4 of this Affidavit.
That this Affidavit is sworn for the purpose of confirming the only Legal Heirs of Late XXXXXXX and filing Income Tax Return for Assessment Year 2018-19.
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That the statement made above is true to my knowledge & Belief and nothing material has been concealed therein and I sign this Affidavit on this the XXX XXXX , 2018 at XXXX Court Premises.
(Sinature of Senjuti Ghosh)
Declarent Identified by me
Advocate, XXXX