In the Court of Ld. Sub Division Executive Magistrate (s)/1st Class at Berhampore, Murshidabad.

AFFIDAVIT

We, 1) Soriful Sk, 2) Jesmina Bibi, S/O & D/O.– Ali Hossain Sk, all by caste Muslim, all
residing at Vill- Lochanmati, P.O.- L. Dangapara, P.S.– Hariharpara, Dist– Murshidabad, West
Bengal, Pin- 742166, do hereby solemnly affirm and declare as follows:-
1. That we are a Citizen of India by birth.
2. That Late Felu Bibi was our mother and our said mother died on 06/07/2023 at the
above mention home address.
3. That at the time of death, our mother was a cultivation in profession and on the demise
the family members are to get Govt. Grand under the Scheme of KRISHK BANDHU
DEATH BENEFIT of 2019 an amount of Rs. 2,00,000/- (Rupees Two Lakh) only.
4. That we are swearing this affidavit to declaring that if the respective authority paid all
the Govt. Grant of KRISHK BANDHU DEATH BENEFIT an amount of Rs. 2,00,000/-
(Rupees Two Lakh) only to our father namely Ali Hossain Sk of our part, then we have
No-Objection and we shall nor raise any objection in future.

Declaration
We, do hereby declare that all statements made in the affidavit are true and correct to
the best of our knowledge & belief if any fraudulence and false suit found in our statements the
concerned authority deserves right to cancel or reject our declaration and application or we
shall be prosecuted as per provision of section 193 IPC having well known with the contents of
or we put our Signature herein.