Date (mm/dd/yy):
Given by:
Name:
Age:
Occupation:
Was he/she known by any other name? If so, what was this name?:
Last fixed address of the deceased:
Date of death (Day, Month, Year):
An Affidavit of Delay is necessary if death occurred 3 years or more before the instructions are given.
Is a certified copy of Death Certificate available?
YesNo
N.B. If not, efforts must be made to obtain one, or a copy of the Order for Burial (pink paper) must be submitted.
Address:
Did the deceased leave a will?
Is/are the Executor(s) named in the Will alive?:
Full name, address and occupation
Are the Attesting Witnesses alive?:
State the full name, address and occupation of someone who can swear to the execution of the Will to be a Testator/trix.
If applicable, state the full name, address and occupation of someone who can depone to either an Affidavit of Handwriting of Attesting Witness or an Affidavit of Handwriting of the Testator/trix.
If the Will is undated, someone who can remember the date it was actually signed must swear to this fact
Name of said individual:
Name of person who wrote or typed the Will:
Address of person who wrote or typed the Will:
Occupation of person who wrote or typed the Will:
Funeral expenses=
N.B. Copies of documentary proof in support of this sum must be obtained, if available.
Mortgage loans and other personal debts=
(a) Realty: (Bare land or land with building(s) thereon):
(b) Personalty: (e.g. Bank Accounts, Insurance Policies, Motor Vehicles, Shares and Stocks, etc.) :
Which was the principal place of residence of the deceased
Which of the above mentioned items of Real Estate (if any) was used as the principal place of residence of the deceased and any other person(s) up to the date of his/her death?
For how many years was this property the principal place of residence?
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