Why This Form Is Important

• It ties the claim to an official record: clause 1 states the date of death and that the death was registered with the municipal authority, giving the certificate number and date, with the original attached.
• It identifies who the legal heirs are: the table lists every surviving member with name, age and relationship to the deceased, which is the information the receiving office needs to decide who is entitled to a surviving member certificate.
• It closes the list of claimants: the clause stating that no one other than the persons named is a surviving member is an exclusive declaration, which helps prevent competing or later claims.
• It creates financial accountability: the deponent agrees to be fully responsible for any loss caused to the department if another surviving member arises in future or the statement turns out to be wrong.
• It serves a stated purpose: the form says the surviving member certificate is required for submission in the Bank and other offices, so this affidavit is a supporting document for those dealings.
• It is a sworn, verified statement: the deponent signs twice and verifies at New Delhi that the contents are true and correct and nothing has been concealed. Note: that a false affidavit carries legal consequences is general knowledge about affidavits in India, not something sourced from an official policy document supplied here.