8/2/2014 Sample Birth Affidavit by Uncle or Close Relative: U.S.

Green Card, Adjustment of Status or Immigrant Visa

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Sample Birth Affidavit - Uncle
AFFIDAVIT
BIRTH OF SMITA
I, the undersigned, Mr. SHAH Kantilal Ramnikbhai, aged - 63 years, Hindu by religion, residing at C-280 Jagdambe
Nagar, Rakhiyal, Ahmedabad 385432, India, do hereby solemnly affirm and declare on oath that:
1. I am the deponent herein and a citizen of India.
2. I was born on April 13, 1946 Bikaner, Rajasthan, India.
3. My sister BHATT Renukaben (mother of Smita) was married to Mr. BHATT Jaydevbhai Hasmukhlal on Oct 7,
1965 in Surat, Gujarat, India.
4. Smita was born on Dec 17, 1967 in Bikaner, Rajasthan, India. I have the personal knowledge of Smita's birth
because I am her uncle (mother's brother) and we are very close relatives and recall Smita's birth clearly
OR I was immediately informed of her birth OR I was present at the time of her birth.
5. Smita's full name at the time of birth was given as BHATT Smita Jaydevbhai.
6. It is a religious custom in India to name the child after its birth in a religious ceremony. Therefore, Smita's
name was not recorded in the original birth registration. Therefore, the official record of birth is incomplete
concerning BHATT Smita Jaydevbhai.
So I do hereby solemnly affirm that foregoing are true and correct statements.
Place: Ahmedabad, Gujarat, India
Date: Dec 30, 2009

DEPONENT
Note: Above affidavit is just a sample. The Microsoft Word template below has been provided solely as a formatting
template and is formatted in such a way that you can directly print on to the standard stamp paper used in India so
that you don't have to go through the hassle of manual typewriter. It is not for filling in the blanks because your
situation will vary.
You should modify the wording accordingly and make your own document. Different sample affidavits on this web
site by different relatives try to cover a few different scenarios. Therefore, the sample affidavits for the same
person vary. However, you should try to make consistent affidavits for your particular case.
[1]
Microsoft Word Template[1]
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8/2/2014 Sample Birth Affidavit by Uncle or Close Relative: U.S. Green Card, Adjustment of Status or Immigrant Visa
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