BEFORE THE TAHSILDAR AT KALHER MANDAL

AFFIDAVIT

I, DAMMAGONI SWAPNA W/O SANGAGOUD , age (34) years 4-64, Kalher Village, Kalher
Mandal, Dist. Sangareddy, do hereby state on oath as under:-

I state that my Father Namely: LATE DAMMAGONI SANGA GOUD S/O MOGULA GOUD, he was
died on 26/03/2019, leaving behind me and the following presence our family members of my deceased Mother.

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SL.NO. NAME OF THE FAMILY MEMBER AGE RELATIONSHIP MARITAL STATUS
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1. DAMMAGONI SWAPNA 34YRS WIFE MARRIED
2. DAMMAGONI MANIDEEP GOUD 15YRS SON UN MARRIED
3. DAMMAGONI MANASWINI 11YRS DAUGHTER UNMARRIED
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I state that I am need of FAMILY MEMBER CERTIFICATE/ LEGAL HEIR CERTIFICATE for
The purpose Death Benefits & record.

The above contents are true and correct to the best of my knowledge, belief and information.

Hence I may kindly issue to me FAMILY MEMBER CERTIFICATE/LEGAL HEIR CERTIFICATE of the
Sworn and signed before me.

Deponent
.