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Format for affidavit to report Post Jab deaths

Posted on August 19, 2021August 19, 2021

Many of us have received a large number of reports of post jab deaths and severe injuries. There is increasing concern that these deaths are not getting onto the official CARM website, or are being rejected by the government gatekeepers.

Louisa, Lynda and their amazing and rapidly growing team started researching and collating these deaths into a People’s Register. This now includes over 80 confirmed post jab deaths and even more suspected post jab deaths.

The database has been overviewed by some wonderful doctors and then forwarded to CARM.

The CARM process is very slow and not transparent, so the next phase to assist public awareness is to encourage families and friends to speak out and share information to alert others. This can be done by video and/ or by written statement known as an “affidavit” that the “deponent” (the person who swears the affidavit) swears is true and correct.

An affidavit is generally regarded as admissible evidence for court.

It’s extremely important that we document as much information as possible about this experimental injection, as often patterns can be observed which help identify problems.

A draft format is below. Please copy and use it to help inform others. It can also be modified and used for post jab injuries.

Thank you ❤️

Affidavit of [ Full Name]


I [ Full name], occupation of location swear/ affirm:


1 I am making this affidavit to record important information about the post Pfizer vaccine death of [ name of deceased].
2 Explain your relationship with the deceased.
3 Explain the health of the deceased prior to jab.
4 Date of 1st jab and any post jab effects.
5 Date of 2nd jab and any post jab effects.
6 Why they had the jab, did they rely on any particular advice, any pressure from employer, professional body, residential care etc
7 Any other information relevant to informed consent etc
8 Effects on family and friends of the death
9 Anything else including any documents annexed eg any health records, autopsy etc. NB: Label each document individually A, B, C etc


Sworn at [ place] this     day of August 2021Before me
Barrister and solicitor of the High Court of New Zealand/ Justice of the Peace

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