Application Form Legal Heir Certificate

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APPLICATION FORM
(Please paste court fee stamp here)
LEGAL HEIR CERTIFICATE
Fields marked with (*) are mandatory
Details of Letter from Department :
Letter No.*
Letter Date*
Issuing Department*
Designation of Issuing Authority*
Address*
Purpose*
Applicant’s Details :
Applicant’s Name*
Relation With Deceased*
Father’s/ Husband’s Name*
Date of Birth*
Gender*
Male
Female
Transgender Aadhaar No
Mobile No*
E-mail*
Applicant’s Address:
House No / Flat No *
Sector / Village*
Tehsil / Sub-District*
District*
State/UT*
Pin Code*
Details of the Deceased :
Name of Deceased*
Father’s/ Husband’s Name*
Designation*
Aadhaar No
Gender*
Male
Female
Transgender
Single
Married
Marital Status*
Date of Death*
Widowed
Divorced
Buddhism
Hinduism
Mother’s life Status*
Alive
Deceased
Jainism
Christianity
Father’s life Status*
Alive
Deceased
Religion*
Islam
Sikhism
Husband’s/ Wife’s Status*
Alive
Deceased
Others (Please Specify)
Address of the Deceased:
House No / Flat No *
Sector / Village*
Tehsil / Sub-District*
Chandigarh
District*
Chandigarh
State/UT*
Chandigarh
Pin Code*
Details of Directly Related Legal Heir: (Mother, Father, Son, Wife, Husband)
Sr.
Relationship with
Marital
Living Status
Name*
Age*
Occupation*
No.
Deceased*
Status*
(Alive/Dead)
1
2
3
4
5
6
Details of Indirectly Related Legal Heir (Grandson, Grand Daughter, Daughter-in-Law etc.)
Name of Deceased
Sr.
Relationship
Marital
Living Status
Name*
Direct Legal Heir
Age*
Occupation*
No.
with Deceased*
Status*
(Alive/Dead)
(mentioned above)*
1
2
3
4
5
Self-Undertaking
I………………………………………………………………Son/Daughter of Sh. ……………………………………………………….. aged
………… resident of …………………………………………………………………………………………………………………., verify and
declare that the information given above and in the enclosed documents is true to the best of my
Photograph of the
knowledge and belief and nothing has been concealed therein. I am well aware of the fact that if the
person applying for
information and document given by me is proved to be incorrect/not true, I shall be liable for
the certificate with
prosecution under section 177 & 191 of the Indian Penal Code, which stipulates imprisonment and fine.
cross signature
)
Date : ……………………………………………
Signature : ………………………………………………………………..
Place: ……………………………………………
Name
: ………………………………………………………………..
*Without cross signature on photograph and undertaking the application will be rejected

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