I (name and address of applicant) solemnly and sincerely declare that I am the (degree of relationship) and next or one of the next of kin of (name of deceased) and that I am entitled to take out administration to his estate and to receive the sum of $ directed to be paid to him by the order dated the 19 .
And I further declare that the total value of the assets of the deceased including the above sum does not exceed $5,000, and I certify that the death-bed and funeral expenses of the deceased have been paid: and I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths and Declarations Ordinance, Chapter 11.
(Signature of applicant)
Declared at
Before me this day of 19 .
(Signature)
Justice, notary public, or other authorized officer.
E 12
[Subsidiary]
CAP. 336]
District Court Suitors' Funds Rules
[1973 Ed.
I (name and address of applicant) solemnly and sincerely declare that I am the (degree of relationship) and next or one of the next of kin of (name of deceased) and that I am entitled to take out administration to his estate and to receive the sum of $
directed to be paid to him by the order dated the
19
And I further declare that the total value of the assets of the deceased including the above sum does not exceed $5,000, and I certify that the death-bed and funeral expenses of the deceased have been paid: and I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Oaths and Declarations Ordinance, Chapter 11.
(Signature of applicant)
Declared at
Before me this
day of
19
(Signature)
Justice, notary public,
or other authorized officer.
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