The authorized person shall attach to the international will a certificate to be signed by the authorized person establishing that the requirements of AS 13.12.912
- 13.12.921 for valid execution of an international will have been complied with. The authorized person shall keep a copy of the certificate and deliver another to the testator. The certificate shall be substantially in the following form:



CERTIFICATE


(Convention of October 26, 1973)


1. I, ________ (name, address, and capacity),


a person authorized to


act in connection with international wills


2. certify that on ________ (date) at ________ (place)


3. (testator) ________ (name, address,


date, and place of birth) in


my presence and that of the witnesses


4. (a) ________ (name, address, date, and place of birth)


(b) ________ (name, address, date, and place of birth)


has declared that


the attached document is the testator's will and that the testator


knows the contents of the will;


5. I furthermore certify that:


6. (a) in my presence and in that of the witnesses


(1) the testator has signed the will or has acknowledged the


testator's signature previously affixed.


* (2) following a declaration of the testator stating that the


testator was unable to sign the testator's will for the following


reason ________ , I have mentioned this declaration on the will


*and the signature has been affixed


by ________ (name and address)


7. (b) the witnesses and I have signed the will;


8. * (c) each page of the will has been


signed by ________ and


numbered;


9. (d) I have satisfied myself as to the identity of the


testator and of the witnesses as designated above;


10. (e) the witnesses met the conditions requisite to act as


witnesses according to the law under which I am acting;


11. * (f) the testator has requested me to include the


following statement concerning the safekeeping of the testator's will:


________________________________________________________________


________________________________________________________________


12. PLACE OF EXECUTION


13. DATE


14. SIGNATURE and, if necessary, SEAL


* to be completed if appropriate.