Delayed Death Registration Affidavit u/s 13(3) of RBD Act (Over 1 Year Delay)

Before the Ld. Concerned Authority / Notary Public At Ghatal, Dist.- Paschim Medinipur, West Bengal AFFIDAVIT (On Non-Judicial Stamp Paper of ₹10 Non-Judicial Stamp Paper) In the matter of: Delayed Death Registration Affidavit u/s 13(3) of RBD Act (Over 1 Year Delay) I, [Deponent Name], [S/O / D/O / W/O] [Father / Husband Name], aged about [Age] years, by faith [Religion], by occupation [Occupation], residing at Vill.- [Village / Ward No.], P.O.- [Post Office], P.S.- [Police Station], Sub-Division- Ghatal, Dist.- Paschim Medinipur, Pin- [Pin Code], West Bengal, do hereby solemnly declare, affirm and state on oath as under:- 1. That I am the lawful son / daughter / spouse of late [Predecessor / Family Member Name], who expired on [Date of Death] at [Place of Death]. 2. That the last rites and cremation were carried out at the local crematorium in the presence of local witnesses. 3. That the death could not be registered within the statutory period of one year due to severe family bereavement and ignorance of legal rules. 4. That no previous death certificate has been registered or issued anywhere in India. 5. That I pray for an order under Section 13(3) of Act 18 of 1969 directing the Concerned Authority to register the demise. Verification:- I, the above-named deponent, do hereby verify and declare that the statements made in paragraphs 1 to 5 above are true and correct to the best of my personal knowledge, belief and derived from authentic records. No material facts have been suppressed, concealed or misstated herein. If any statement is subsequently found to be false or incorrect, I shall be liable to face statutory legal prosecution under the Indian Penal Code / Bharatiya Nyaya Sanhita and relevant provisions of Registration of Births and Deaths Act 1969 u/s 13(3). Solemnly affirmed and signed on this [Date] day of [Month], [Year] at Ghatal. ___________________________ Deponent Signature / LTI Identified by me and signed in my presence: ___________________________ Advocate, Ghatal Dewani Court Dist.- Paschim Medinipur, West Bengal