Affidavit sworn before a magistrate stating the date of birth format

I apply pan for my mother. But no proof available for DOB. So i need Affidavit sworn before a magistrate stating the date of birth formatt.

Please any one provide the format and guide me for further process.

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FORMAT FOR AFFIDAVIT FOR DATE OF BIRTH

I, . son/daughter of Shri. resident of . (complete address) affirm on oath and declare as under :-

1. That I / my son / daughter was born on . and hence, my date of birth is . / date of my minor son/ daughter Mr./Miss. . is .

1. That I have no other proof of my birth date / birth date of my son/daughter Mr./Miss . And hence, I am declaring date of birth by this affidavit.

Verification

I, . son of Shri. hereby verify that as per my best knowledge above mentioned contents of this affidavit are true and correct and nothing was hidden there from.