IN THE HIGH COURT OF JUSTICE Extracting solicitors: <solicitors name>

Address: <solicitors address>

The Probate Registry of <office location>

IN the Estate of <deceased's full name> deceased

<We/I> <first executors full name> of <first executors address> <and> <second executors
full name> <of> <second executors address> make Oath and say that <I/we> believe the
paper writing now produced to and marked by <us/me> to contain the true and original last
Will and Testament <with> <number of codicils> <Codicil/Codicils> of <deceased's full
name> deceased whose name was registered as such in the Register of Deaths who was
born on the <day number> day of <month year> and died on the <day number month
year> aged <age> years domiciled in England and Wales and that to the best of <our/my>
knowledge, information and belief there was no land vested in the said deceased which
was settled previously to his death (and not by <his/her> Will) and which remained settled
land notwithstanding <his/her> death;

And that we further make Oath and say that <we are/ I am> the <Executors/Executor>
named in the said Will <with> <number of codicils> <Codicil/Codicils> and that <we/I> will
(i) collect, get in and administer according to the law the real and personal estate of the
said deceased; (ii) when required to do so by the Court, exhibit in the Court a full inventory
of the said estate and when so required render an account of the administration of the said
estate to the Court; and (iii) when required to do so by the High Court, deliver up the grant
of probate to that Court; and that to the best of <our/my> knowledge, information and
belief the gross estate passing under the grant does not exceed £<inheritance tax nil rate
band> and the net estate does not exceed £<IR205 - Net estate in the UK rounded up to
the next £1,000> and this is not a case in which an Inland Revenue Account is required to
be delivered.

SWORN by the above named Deponent )

<first executors full name> )
)
at )
this day of )

Before me
A Commissioner for Oaths/Solicitor

SWORN by the above named Deponent )

<second executors full name> )
)
at )
this day of )

Before me
A Commissioner for Oaths/Solicitor