I _________ wife of _________ resident of _________ do hereby solemnly affirm and declare as under: –
1. That I have not received any kind of pension from _________ and from any other state from the same.
2. That I am a citizen of _________ and residing in _________ for last _________ years.
3. That my correct date of birth / age is _________ years.
4. That I confirm that my husband had died on _________ at _________.
5. That I further confirm that Death Certificate of my husband (which is issued by _________) is enclosed, details are below.
a. Serial No.: _________
b. Registration No.: _________
6. That my Whole family income with all sources is about _________ /- Monthly and _________ /- Annually.
7. That I am fully entitled to get the Widow pension from the _________.
8. That this is my true statement.
I, the above named deponent do hereby verify that the contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.