The authorized person shall attach to the will a certificate, to be signed by him or her, establishing that the requirements of this chapter 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
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The authorized person shall attach to the will a certificate, to be signed by him or her, establishing that the requirements of this chapter 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 his or her will and that he knows the contents thereof.
“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 his signature previously affixed.
“(2) [to be completed if appropriate] following a declaration of the testator stating that he or she was unable to sign his 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) [to be completed if appropriate] 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 such according to the law under which I am acting;
“11. (f) [to be completed if appropriate] the testator has requested me to include the following statement concerning the safekeeping of his will:
“12. PLACE OF EXECUTION
“13. DATE
“14. SIGNATURE and, if necessary, SEAL.”