AFFIDAVIT

I Shri, Ketan Satish Rokade son of Shri Satish Rokade,

aged 27 years about ,Occupation Service residing at 501,
Kadam CHSL., Ganesh ghat, beside the wine hotel, , Badlapur
east, Dist.- Thane , State of Maharashtra state on solemn
affirmation as under:
1. That Late Smt. KAMBLE KALAWATI GOVIND was my
GRAND MOTHER.

2. That her date of death was on 21/03/2021 at 20:30 hrs.

3. That KAMBLE KALAWATI GOVIND possesses Aadhar and its

number is 3227 8608 0587

4. That her place of death was at 501, Kadam Co-operative Housing

Society Limited, Ganesh ghat, beside D wine hotel, Badlapur East

5. That her last rituals was performed at MANJARLI SMASHAN

BHUMI ELECTRIC CREMATORURIVM on 22/03/2021 at13:40
hrs.

6. That this affidavit is sworn into obtain death Certificate from the
competent authority i.e. Kulgaon badlapur Muncipal Corporation,
Kulgaon , Badlapur East. 421503

DECLARATION

I Shri Ketan Satish Rokade declare that the above statements

from Para 1 to 6 are true to the best of my knowledge and belief, if
any false declaration, I shall be liable to punishment as per the
provision of Aadhar Act, 2016 and also the registration of Birth &
Death Act, 1969.

DEPONENT