AFFIDAVIT

We 1) Asha A Revankar Jain D/o, Late Premananda Pavuskar, About 53 Years

2) Ashik A Revankar S/o Late Ananth A Revankar, Aged about 29 Years 3) Akshay A
Revankar S/o Late Ananth A Revankar, Aged About Years 4) Vanitha A Jain W/o
Harish Kothari ,Aged About 30 Years 5) Kunal A Jain S/o M Ashok Kumar, Aged
About 26 Years, All residing at care of Door No. 430, A M Galli, Davangere-
577001, do hereby solemnly affirm and state on Oath as follows:

Continued to P/2
 Page-2

1. That We hereby declare that Deponent No.1, is Husband of the Deceased

Rekha A Jain and Deponent Nos. 2 to 5 are Children of the Deponent No. 1 and
Deceased Rekha A Jain. All are Indian Citizens and Permanent Residents of
Davangere.
2. That We hereby declare that Wife of Deponent No. 1 and Mother of Deponent
No. 2 to 5, Smt. Rekha A Jain was died on 21-03-2021 at K.M.C Hospital
Manipal, Udupi, Karnataka.
3. We hereby declare that Late Smt. Rekha A Jain, left behind the following
persons as her only legal Heirs and we declare that we have duly obtained the
Legal Heir Certificate from Competent Authority:
Sl. Relationship
Name PAN Number Address Age
No. with Deceased
1 M ASHOK KUMAR JAIN AIHPK6353P DAVANGERE HUSBAND 63
2 DIMPLE H KOTHARI AZIPK6952C DAVANGERE DAUGHTER 35
3 CHETHANA OSWAL ASYPC1713E DAVANGERE DAUGHTER 33
4 VANITHA A JAIN BDJPJ8510R DAVANGERE DAUGHTER 30
5 KUNAL A JAIN AZOPJ3880E DAVANGERE SON 26
4. That we hereby declare that there are no other Legal Heir/s of Late Rekha A
Jain except the Names as mentioned in Clause 3 of this Affidavit.
5. That this Affidavit is sworn for the purpose of confirming the only Legal Heirs
of Late Rekha A Jain and for filing Income Tax Return for Assessment Year 2021-22.
We do swear in the name of God that this is Our Name and Signatures and the
contents of this affidavit are true and correct.

Identified by me 1.

2.
Roll No. KAR/583/91
3.

4.

5.

Date: 22/11/2021 (Deponents)

Place: Davangere