Sample Birth Affidavit – Mother



I, the undersigned, BHATT Renukaben Jaydevbhai aged – 64 years, Hindu by religion, presently residing at 23 Gulmahor Society, Alkapuri, Baroda – 390001, India, do hereby solemnly affirm and declare on oath that:

  1. I am the deponent herein and a citizen of India. 

  2. (If currently in the USA)
    I am currently visiting the United States and temporarily residing at my daughter GUPTA Manisha’s house at 23445 W Parker Road, Allen, TX 75002.


    I am a permanent resident of the U.S. My A Number is A1234567.

    I am a naturalized U.S. citizen. My naturalization certificate number is 34789035489, and I was naturalized on Feb 17, 2015, in Fairfax, Virginia.

  3. I was born on Mar 17, 1954, in Bikaner, Rajasthan, India.

  4. I was married to BHATT Jaydevbhai Hasmukhlal on Oct 7, 1975, in Surat, Gujarat, India.

  5. As it is customary, I had gone to my parents’ place in Bikaner, Rajasthan, India, for the delivery of our first child in Nov 1977.

  6. Smita was born on Dec 17, 1977, in Bikaner, Rajasthan, India. I have the personal knowledge of her birth because I am her mother, and I gave her birth.

  7. Smita’s full name at the time of birth was given as BHATT Smita Jaydevbhai. 

  8. Smita’s birth was registered later because it was not customary at that time to register the birth of children. 


    Smita’s birth was not registered with the Records Office of Bikaner, Rajasthan, India, and therefore, a birth certificate is not available at this time.


    Smita’s birth was registered with the Records Office of Bikaner, Rajasthan, India. However, Smita’s name was not listed on the birth certificate at the time of registration. 


    Smita’s birth was registered with the Records Office of Bikaner, Rajasthan, India. However, due to civil unrest/war in Rajasthan, India, the birth certificate is not available at this time. 

  9. I, BHATT Renukaben Jaydevbhai and my husband, BHATT Jaydevbhai Hasmukhlal had the following children born from our marriage: 

    BHATT Smita Jaydevbhai (After marriage, JADAV Smita Dipesh)
    BHATT Manisha Jaydevbhai (After marriage, GUPTA Manisha)
    BHATT Sanjay Jaydevbhai
    BHATT Vaishali Jaydevbhai

  10. Smita was married to JADAV Dipesh Morarilal on Apr 2, 2002, in Ahmedabad, Gujarat, India. I had attended their wedding.

So I do hereby solemnly affirm that foregoing are true and correct statements.

Place: Baroda, Gujarat, India
Date: March 30, 2019


Note: The 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 a 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.

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