WE (1)______________________________, (2) ______________ __________________ and (3)
__________________________, all of ________, adults, Indian Inhabitants, residing at
______________________________, do hereby solemnly affirm and state as under:-

1. We are the only legal heirs and representatives of late
Shri ____________________ who died on _________. (hereinafter called “the said
deceased” ). The original death certificate of the said deceased is annexed as Annexture
“A” hereto.
2. Our relationship with the said deceased is as under:—
Name Relationship
(i) ____________________________ Wife/Widow
(ii) ____________________________ Unmarried daughter
(iii) ____________________________ Son
We and the said deceased are Hindus and are governed by The Hindu law. We hereby state
that save and except ourselves there are no other legal heirs and representatives of the
said deceased.
3. The said deceased at the time of his death was the sole owner of the residential property
namely __________________________ and which property is more particularly described
in the Schedule hereunder written and the same is hereinafter referred to as “the said
property”.
4. The said deceased died intestate leaving us as his only legal heirs and representatives
according to Hindu Law. We hereby further state and declare that save and except
ourselves there are no other legal heirs and representatives of the said deceased. Since,
the said deceased died intestate and as we are the only legal heirs and
representatives of the said deceased we are entitled to the estate of the said
deceased in equal share i.e. 1/3rd to each of us.
OR

The said deceased died leaving a will dated ___________. By the said will the deceased
has devised and bequeathed the said property to the Deponents hereto, a copy of which is
annexed as Annexture “B” hereto. The said will is duly accepted and acted upon by all of
us.
5. Accordingly, we each of the Deponents have become entitled to 1/3rd share each in the said
property.

OR

In view of the said Will, the Deponent No.1 has solely become entitled to the said property.
We all the Deponents hereby give our consent and no objection for transferring the said
property in the sole name of ______________________, the Deponent No.1 hereto.
6. We are executing this Indemnity-Declaration to enable the appropriate Government
Authorities including Collector/s Officer, City Survey Office, Talati, Tahsildar, Municipal
Corporation, Electricity Board and other authorities for transferring the said property as
aforestated.
7. We jointly and severally agree to keep indemnified and hereby indemnify and keep
harmless the Collector, his Officers, Office of the Collector, City Survey Office, City Survey
and Land records, office of the Assessor and Collector, Talati, Tahsildar, Municipal
Corporation, Electricity Board as also Government and Semi-Government authorities

including their office-bearers, employees, staff and their successors from and against any
loss, damage, demand, action, dispute, claim, costs, charges and expenses of any nature
that may be suffered or sustained by them on account of their act/s and steps taken in
transferring the said property in terms aforesaid in their respective records.

SCHEDULE OF THE ABOVE PROPERTY
(Give detailed description of the property)

SOLEMNLY AFFIRMED AND )
DECLARED by the within named ) (1)
(1) ________________________ ) (2)
(2) _________________________ ) (3)
(3) ______________________________ ) Before me,
Notary/Magistrate