If you're applying for a Family Member Certificate (FMC), this article provides a sample notarised affidavit, a fill-out application, a specimen Family Member Certificate format, and an employer-issued family certificate format.
The formats below are illustrative examples only. The wording, document design, and Family Member Certificate application procedure may vary between states and issuing authorities. Always follow the instructions issued by the concerned Revenue Department or authorised service portal.
Family Member Certificate Notarised Affidavit Sample Format
A notarised affidavit is a declaration by the applicant giving the deceased person's details and listing the surviving family members.
AFFIDAVIT
(For Obtaining Family Member Certificate)
I, , Son / Daughter / Wife of , aged about years, residing at , do hereby solemnly affirm and declare as follows:
- That Late Sri/Smt expired on at .
- That the deceased was my (Relationship).
- That the following are the surviving family members of the deceased.
| S.No | Name | Relationship | Age | Aadhaar Number |
|---|---|---|---|---|
| 1 | ||||
| 2 | ||||
| 3 | ||||
| 4 | ||||
| 5 |
- The details furnished above are true and correct to the best of my knowledge.
- No surviving family member of the deceased has been intentionally omitted from this affidavit.
- This affidavit is submitted for the purpose of obtaining a Family Member Certificate.
DEPONENT
(Signature)
Verification
I hereby verify that the contents of this affidavit are true and correct to the best of my personal knowledge and no part of it is false.
Verified at on this day of 20 .
For Notary Use
Signature of Notary:
Registration Number:
How to Get a Family Member Certificate Affidavit Notarised
To notarise the affidavit, the applicant (who should be one of the surviving family members of the deceased) must sign the affidavit on the non-judicial stamp paper before a licensed Notary Public.
The notary verifies the applicant's identity using original documents (such as an Aadhaar Card or Voter ID), administers the oath or affirmation, witnesses the applicant's signature, and affixes the authorised signature, registration number, and notarial seal.
Note: The notary does not certify that the statements made in the affidavit are factually true. The person signing the affidavit is responsible for ensuring that all the information provided is correct(alert-passed).
How much cost to notarise an FMC affidavit?
The total cost of notarising a Family Member Certificate (FMC) affidavit varies depending on the state, stamp paper requirement, drafting charges, and the notary's fee.
| Cost Component | Typical Cost / Requirement |
|---|---|
| Non-judicial stamp paper | Varies by state and local requirement |
| Document drafting | May apply if drafted by an advocate or document writer |
| Notarisation fee | Varies depending on the state and notary |
| Common all-inclusive amount | Approximately ₹100–₹300 in some locations |
Who can notarise a Family Member Certificate affidavit?
Under Section 3 of the Notaries Act, 1952, the Central or State Government appoints legal practitioners or other persons who possess the qualifications as Notaries to perform notarial acts such as administering affidavits and authenticating documents.
How to Identify an Authorised Notary
After appointment, a notary who intends to practise must have their name entered in the recognised Register of Notaries and obtain a Certificate of Practice.
A Notary's Certificate of Practice is generally issued for a period of five years and may be renewed in accordance with Section 5 of the Notaries Act.
Every practising notary must use their official signature and notarial seal when notarising documents. Before submitting your affidavit, check that both appear on the document.
Tip: A notary should generally notarise documents only within the jurisdiction specified in their Certificate of Practice. To avoid unnecessary issues, it is advisable to use a practising notary in the same district or local area where you are applying for the Family Member Certificate(alert-success).
Where to Get Your FMC Affidavit Notarised
If you're unsure where to get the affidavit notarised, here are the most common and reliable options:
- Near the Tahsildar / RDO / Mandal Revenue Office: Notaries and stamp vendors are commonly available near Revenue offices.
- Local court complexes: District and sub-court premises have practising notaries nearby, since most notaries are also advocates.
- Independent notary offices and stamp vendor shops: These are common in many towns. Look for a signboard reading "Notary Public" along with a registration number and seal on display.
- Online notary directories: Some states publish an official list of licensed notaries by district on their Law Department websites. The central notary.gov.in portal also provides notary registration details.
How to Fill the Family Member Certificate Application Form (Step-by-Step)
Before filling in the Family Member Certificate application, keep the applicant's Aadhaar Card, the deceased person's Death Certificate, and the available family records together. Enter names and dates exactly as they appear on the supporting documents. Avoid using nicknames or abbreviated names.
If the same person's name is spelt differently on two documents, don't simply choose one version yourself. Check which document the issuing authority expects you to use as the primary reference, because inconsistencies in names, dates, Aadhaar numbers, or relationships may lead to additional verification or delay the application.
Field names vary by state, but the required information is largely the same.
Applicant Information
| Field | What to Enter |
|---|---|
| Aadhaar Number | Write the applicant's 12-digit Aadhaar number as per Aadhaar. |
| Applicant Name | Write the full name without spelling variations. |
| Gender | Select Male, Female or Transgender. |
| Date of Birth | Fill in the applicant's Date of Birth in DD/MM/YYYY format. |
| Permanent Address | Enter the complete address including Door Number, Locality, Village/Ward, Mandal/Taluk, District and PIN Code. |
| Present Address | If different from the permanent address, enter the current residential address. |
| Mobile Number | Provide an active mobile number to receive SMS updates. |
| Email Address | Optional, but recommended for online communication. |
| Remarks | Leave blank unless additional information is needed. |
| Ration Card Number | Write the family ration card number, if available. |
Details of the Deceased
| Field | What to Enter |
|---|---|
| Name of Deceased | Write the full name as shown on the Death Certificate. |
| Father's/Husband's Name | Mention the father's or spouse's name wherever requested. |
| Date of Death | Enter the date as recorded on the Death Certificate. |
| Reason for Death | Select the relevant option such as General Death, Ill Health, Accident, Flood, Fire, Suicide, Missing or other available category. |
| Occupation | Select the occupation applicable before death. |
| Aadhaar Number | If available, mention the deceased person's Aadhaar number. |
| Death Place | Mention the place where the death occurred. |
Family Member Details
List every surviving immediate family member of the deceased person.
| Field | Instructions |
|---|---|
| Name | Enter the full name same as Aadhaar. |
| Age | Current completed age. |
| Gender | Select Male or Female. |
| Relationship | Choose the correct relationship such as Wife, Husband, Son, Daughter or Mother. |
| Marital Status | Select Married or Unmarried. |
| Aadhaar Number | Provide the Aadhaar number of each surviving family member. |
Family Member Certificate Sample Format (Reference)
The specimen below illustrates the information included in a Family Member Certificate.
GOVERNMENT OF [STATE]
REVENUE DEPARTMENT
FAMILY MEMBER CERTIFICATE
| Certificate No. | Date of Issue | ||
| Application No. | District |
This is to certify that Late S/o / D/o / W/o who was residing at expired on ____ / ____ / ______.
The following are the surviving family members of the deceased.
| S.No | Name of Family Member | Relationship | Age | Gender | Marital Status | Aadhaar Number |
|---|---|---|---|---|---|---|
| 1 | Wife / Husband | |||||
| 2 | Son | |||||
| 3 | Daughter | |||||
| 4 | Mother |
This certificate is issued for administrative purposes only and certifies the surviving immediate family members of the deceased. It shall not be treated as a Legal Heir Certificate and does not confer inheritance rights.
Tahsildar
Official Seal
How to Verify a Family Member Certificate
Many Family Member Certificates issued through state e-governance portals are digitally signed and carry a unique certificate or application number that can be checked online.
- Certificate/Application Number: Enter this on the issuing state's revenue or e-services portal (for example, MeeSeva-based portals in Andhra Pradesh and Telangana) to pull up the certificate status and confirm it matches the printed copy.
- QR Code or Barcode: Many recent certificates carry a QR code that, when scanned, links directly to the digital record — useful for third parties (banks, insurers, employers) who need to confirm authenticity without contacting the Revenue office directly.
- Digital Signature Certificate (DSC): Certificates issued electronically are signed with the issuing officer's DSC, which can be validated using standard PDF viewers if the file was downloaded from the official portal.
Older certificates issued manually (signed and sealed on paper without a portal-generated number) don't have any of these digital verification options — in that case, contact the issuing Tahsildar's office directly.
Government FMC vs Employer-Issued Family Certificate
Although both documents have similar names, they are used in different situations. If you are looking for a family member certificate on the employer's own letterhead, the table below explains how this employer-issued document differs from a Government FMC.
| Aspect | Government FMC (Tahsildar-issued) | Employer-Issued Family Certificate |
|---|---|---|
| Issued by | Revenue Department (Tahsildar) | Employee's company / HR department |
| Purpose | Proves relationship of survivors to a deceased person for pension, insurance, or welfare claims. | Records an employee's current living dependents for company records. |
| When Used | After the death of a family member. | During onboarding, health insurance, PF nomination, gratuity, or ESI. |
| Verification | Field verification, notarised affidavit, and public notice period. | Usually self-declaration by employee and sometimes HR verification. |
| Legal Standing | Official government revenue record. | Internal HR/company record only. |
| Format | Standard government format. | Company letterhead; varies by organization. |
Employer-Issued Family Member Certificate: Sample Template
If your HR department asks for this document, it follows a format similar to the one below.
[COMPANY NAME]
[COMPANY ADDRESS]
FAMILY MEMBER CERTIFICATE
This is to certify that Mr./Ms. ,
Employee ID:
Designation:
Department:
has declared the following family members as on .
| S.No | Name | Relationship | DOB | Aadhaar |
|---|---|---|---|---|
| 1. | ||||
| 2. | ||||
| 3. |
This certificate is issued based on the declaration furnished by the employee and is used only for insurance enrollment, gratuity nomination, PF nomination, or internal HR purposes.
Authorized Signatory
Name:
Designation:
Company Seal
Date:
Frequently Asked Questions
Is a notarised affidavit mandatory for an FMC?
No. The requirement for an affidavit, including the stamp paper value, wording, and notarisation procedure, depends on the state, district, and issuing authority.
The specimen above is a general reference format and should not be treated as a universal government form. Before preparing the affidavit, check the current requirements of the concerned Revenue Department or authorised service portal.
Can the affidavit be on plain paper?
No. The affidavit is typically prepared on a non-judicial low-denomination stamp paper (such as ₹20 or ₹50, depending on state rules).
Can someone living abroad be included?
Yes. A surviving family member living abroad must still be included in the affidavit and the Family Member Certificate application. Living outside India does not affect their status as a surviving family member.
Conclusion
Keep the names, dates and relationship details consistent with the supporting documents. Because FMC procedures vary by state and issuing authority, check the current requirements before submitting the application or affidavit.