1964_SUPREME_COURT_SUITORS__FUNDS_RULES — Page 11

1979 Ed.]

Supreme Court Suitors' Funds Rules

[CAP. 4

B 11

[Subsidiary]

FORM 6

Declaration

[rule 11(2).]

IN THE SUPREME COURT OF HONG KONG

(Title of cause or matter. No.

Ledger account

of 19

>

(if the same as the cause, state as above)

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.

Declared at

Before me this

day of

(Signature of applicant)

(Signature)

*

19

Justice, notary public, or other authorized officer,

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