The authorized person shall attach to the will a certificate to be signed by the authorized person establishing that the requirements of this subchapter for valid execution of an international will have been fulfilled. The authorized person shall keep a copy of the certificate and deliver another to the testator. The certificate must be substantially in the following form:

CERTIFICATE

I, ________________ (name, address and capacity), a person authorized to act in connection with international wills, certify that on ________________ (date) at ________________ (place) (testator) ________________________________ (name, address, date and place of birth) in my presence and that of the witness (a) ________________ (name, address, date and place of birth) and (b) ________________________________ (name, address, date and place of birth)

has declared that the attached document is his or her will and that he or she knows the contents thereof.

I furthermore certify that:

(a) In my presence and in that of the witnesses:

(1) The testator has signed the will or has acknowledged his or her signature previously affixed.

(2) * Following a declaration of the testator stating that he or she was unable to sign the will for the following reason ________________, I have mentioned this declaration on the will, * and the signature has been affixed by ________________________________ (name and address);

(b) The witnesses and I have signed the will;

(c) * Each page of the will has been signed by ________________________________ and numbered;

(d) I have satisfied myself as to the identity of the testator and of the witnesses as designated above;

(e) The witnesses met the conditions requisite to act as such according to the law under which I am acting;

(f) * The testator has requested me to include the following statement concerning the safekeeping of the will:

PLACE OF EXECUTION

________________________________ DATE

____

________________________________ SIGNATURE and, if necessary, SEAL

* to be completed if appropriate

71 Del. Laws, c. 81, § 2; 70 Del. Laws, c. 186, § 1.