I, __________, __________ of the deceased named below, resident of __________, do hereby solemnly affirm and declare as under:
1. That I am the deponent above named and am competent to swear this affidavit.
4. That this death has not previously been registered under the Registration of Births and Deaths Act, 1969.
8. That the contents of this affidavit are true and correct to my knowledge, no part of it is false, and nothing material has been concealed therefrom.