Next of Kin Declaration Form - Baker & Associates Law Firm

PART A: Client Information

Full Name *

Date of Birth *

Contact Number *

Residential Address *

Email Address *

National ID / Passport Number *

Social Security Number (SSN) *

PART B: Next of Kin Information

Full Name *

Relationship to Client *

Date of Birth *

Contact Number *

Residential Address *

Email Address *

National ID / Passport Number *

Social Security Number (SSN) *

PART C: Supporting Documents

Please attach photocopies of the following (per Tennessee Code Annotated § 47-10-101):

Government-issued Photo ID (Tennessee Driver's License, U.S. Passport, or State-issued ID Card)

Social Security Card or official SSN documentation

Proof of Current Address (Utility Bill dated within 60 days, Bank Statement, or Lease Agreement)

PART D: Declarations

Client Declaration

I, , hereby acknowledge that the information provided in this form is true, accurate, and complete to the best of my knowledge. I understand that any false declaration may result in legal consequences.

Client Signature *

Date *

Print Name *