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AFFIDAVIT OF LIFE CERTIFICATE
I, ______, of the city of ______, in the province/state of ______, DO SWEAR AND AFFIRM:
I, ______, was born on ______ in ______.
I am a citizen of ______.
I currently live at ______.
I solemnly declare and affirm that I am alive.
The purpose of this Affidavit is ______.
Additional information
Proof of Identity: ______
Purpose of Affidavit: ______
Recipient, Program or Destination for Affidavit: ______