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Get Statutory Declaration Form 2019-2024

Hould be attached to evidence the dependency relationship eg. joint bank accounts, shared living expenses, joint liabilities. I wish to be considered for the following reasons: Please attach document if additional space required 7. I would not object to the proceeds being paid to: Legal Personal Representative of the Deceased Other (Please provide details below) Name and address of beneficiary Mr Mrs Miss First name Ms Other Middle name Last name Relationship Portion of total benefit %.

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