AFFIDAVIT

I Smt. Rama Das aged about 47 year S/o Late Bibi Das village : Laxmipur Po:
Alarigada, Ps : Hinjili, Dist : Ganjam, do here by solemnly affirms on oath states
as follows.
1. I am the deponent of this affidavit.
2. That, my Husband namely Bibi Das S/o Bhaiga Das was died on dated
08-10-2023 at our residence Laxmipur, Dist Ganjam
3. That, due to ignorance I and my family members could not able to
intimate the Death event of my husband before CHC Sheragada in time,
4. That, I could not receive my husband’s death certificate from any
authority of Odisha as well as India.
5. That, it is required for ROR change purpose..
6. That, this affidavit is to be produced before the authority concerned
ADMO(PH), Berhampur to give direction to the Registrar Births and
Deaths, CHC Sheragada to register my husbands death event in his
register and issue a death certificate in my husband’s favour.
7. That above mentioned facts all are true, correct and belief to the best of
my knowledge.
Identified by
Deponent

Advocate