AFFIDAVIT FOR FAMILY TREE

I, _______________________________, W/o. ____________________________, aged about

__ years, Occ: _____________, R/o. _______________________________________________

______________________________________________________________________________
Telangana State, do solemnly affirm and state on oath as under:-

1. That I am the deponent herein and us such I am well acquainted with the facts of this
affidavit.

2. That my (husband) Late _______________________, S/o./D/o/W/o ___________________,

expired on dt. ___________ at ________________________________ leaving behind the
following as legal heirs/family members.

3. The Legal Heir Certificate is requested to be issued on the below mentioned family
members as Legal Heirs of Late Sri ________________________________________

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 S.No. Name Age Relation Status
1 Ex. Married
2
3
4
5

4. That the above particulars regarding successors of my deceased

(husband/wife/father/mother) Late. ________________ who died on _____________
which is true and correct to the best of my knowledge and belief. The said successors are
only the legal heirs and successors.

Hence I request the Hon’ble Mandal Authorities to kindly issue LEGAL HEIRS/ FAMILY Members
Certificate.

If at any point of time, it is detected that I have obtained the certificate by falsely and claimed
wrongful means, I may be penalized under relevant sections of IPC and forfeit all benefits
claimed under this certificate.

Sworn and signed before me

On this the ___ of ___________, 20__
At Hyderabad. DEPONENT

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