APPLICATION FORM FOR SUCCESSION CERTIFICATE.

[Death certificate of deceased and 3 (Three) Nos. Passport size photographs of the applicant to be attached
with this application.]

1. Name of deceased:

2. Fathers/ Husbands Name:

3. Permanent home address:

VillagePO-

..
..

PS-

Dist-

State-

4. Name of applicant:

5. Relation with deceased. :

6. Present address :
VillagePO-

PS-

Dist-

State-

7. Details of debts applied for.

Sl.
Details of debts
Name & Address of debtor
No.
1

Amount

Remarks

8. Name and address of family members.

9. Name & Address of relatives of deceased. .

Certified that the information furnished above is true to the

best of my knowledge and belief.

Signature of applicant with date.