AFFIDAVIT FOR DEATH CERTIFICATE

I Shri B NARENDRA, S/of Shri BOGA MADHUKAR, aged 32 Years, Occupation: Private
Employee, Permanent resident of D.No: 4-32-299, LB Nagar, Shapur Nagar, New Vijaya Public
School, IDA Jeedimatla, Qutubullapur, R.R District, Telangana – 500055. (AADHAR: 4501 1497
5171) do hereby solemnly allirm and stale on oath as under.

I am deponent herein hence well acquainted with the facts of this affidavit.

1. That Late BHOGA LALITHA was my GRAND MOTHER.

2. That her date of death was on 30 JULY 2023.

3. That BHOGA LALITHA possesses Aadhar and its number is 6153 2612 6726.

4. That her place of death was at D.No: 4-32-299, Shapur Nagar.

5. That her place of Cremation was at SATYA HARICHANDRA SMASANA VATIKA, KALAVATHI
NAGAR, SHAPUR NAGAR on 30/07/2023 with Burrial Ground reg. No 023 .

6. That this affidavit is sworn into obtain death Certificate from the competent authority.

That due to illiteracy and her sudden death I have not informed the same to the concerned
authorities. As such I request the authorities to issue Death Certificate of my grand mother
Late BHOGA LALITHA, W/o. Late BHOGA NARSIMHA and also request the authorities to
register the same in Birth and Death Records of 2023.

DECLARATION

I Shri/Smt. BOGA NARENDRA 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, u/s 199 & 200 IPC and also the registration of Birth &
Death Act, 1969.

SWorn & Signed before me on this DEPONENT

16TH DAY OF AUGUST 2023 AT HYDERABAD