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1. Title and Venue: Formal title of the document and jurisdiction where it is being executed
2. Declarant Information: Full legal name, address, and relationship to the deceased
3. Deceased Person's Information: Full legal name, last known address, and other identifying information of the deceased
4. Facts of Death: Date, location, and circumstances of death as known to the declarant
5. Documentation Reference: Reference to death certificate or other official documentation confirming the death
6. Purpose Statement: Statement of the purpose for which the affidavit is being made
7. Verification: Sworn statement verifying all information provided is true and correct
8. Execution Block: Space for declarant's signature, date, and notary authentication
1. Additional Witnesses: Section for additional witnesses who can verify the death, used when primary documentation is limited
2. Asset Declaration: Statement regarding the deceased's known assets, used when the affidavit is for inheritance or estate purposes
3. Medical Information: Additional medical details about the death, used when required for insurance or legal proceedings
4. Previous Names: List of any previous names used by the deceased, included when the deceased was known by multiple names
5. Beneficiary Information: Details of known beneficiaries or heirs, included when relevant for estate matters
1. Death Certificate: Certified copy of the official death certificate
2. Identity Documents: Copies of deceased's identity documents (KTP, passport, etc.)
3. Supporting Documents: Additional documentation supporting the facts stated in the affidavit (medical records, police reports, etc.)
4. Witness Statements: Written statements from additional witnesses, if applicable
5. Translation Certificate: Certified translation if original documents are not in Indonesian or English
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