Personal Status Affidavit Sample
Sample Personal Status Affidavits for Aliyah
Here are sample templates for different marital statuses. **Note: **Always use the official forms provided by your Israeli consulate or Jewish Agency, as requirements may vary by location.
SAMPLE 1: SINGLE (Never Married)
PERSONAL STATUS AFFIDAVIT
(Single/Never Married)
State of: __ County of: __
I, __ __ (Full Legal Name), being duly sworn,
do hereby depose and state:
- I am __ __ years of age, born on __ __ (Date) in
(City, Country).
- My current address is:
- My passport number is:
- I declare under oath that:
a) I have NEVER been married in any civil, religious, or common-law capacity.
b) I have never entered into a domestic partnership or civil union that
would be considered a marriage under any jurisdiction.
c) I am legally free to marry according to the laws of
(Country) and according to Jewish law (Halacha).
d) There are no legal impediments to my marriage.
- I make this affidavit in support of my application for aliyah (immigration)
to the State of Israel.
- I understand that this statement is made under penalty of perjury and that
false statements made herein may result in denial of my application and/or
criminal prosecution.
Signature of Affiant Date
Printed Name
SWORN TO AND SUBSCRIBED before me this __ __ day of
__, 20 __.
[NOTARY SEAL]
Notary Public
My Commission Expires:
SAMPLE 2: MARRIED
PERSONAL STATUS AFFIDAVIT
(Married)
State of: __ County of: __
I, __ __ (Full Legal Name), being duly sworn,
do hereby depose and state:
- I am __ __ years of age, born on __ __ (Date) in
(City, Country).
- My current address is:
- My passport number is:
- I declare under oath that:
a) I am legally married to
__ __ (Spouse's Full Legal Name).
b) We were married on __ __ (Date) in
__ __ (City, Country).
c) The marriage was performed by
__ __ (Name
and title of officiant) in a [civil/religious - specify] ceremony.
d) This marriage is my [first/second/etc.] marriage.
e) I have never been divorced. [OR: I was previously married to
and that marriage was legally dissolved by divorce on
__ __ (Date).]
f) My spouse's date of birth is:
g) My spouse's passport number is:
h) My spouse [IS / IS NOT] making aliyah with me at this time.
- Attached to this affidavit are the following documents:
□ Certified copy of marriage certificate
□ [If applicable] Copy of spouse's passport
□ [If applicable] Previous divorce decree(s)
- I make this affidavit in support of my application for aliyah (immigration)
to the State of Israel.
- I understand that this statement is made under penalty of perjury and that
false statements made herein may result in denial of my application and/or
criminal prosecution.
Signature of Affiant Date
Printed Name
SWORN TO AND SUBSCRIBED before me this __ __ day of
__, 20 __.
[NOTARY SEAL]
Notary Public
My Commission Expires:
SAMPLE 3: DIVORCED
PERSONAL STATUS AFFIDAVIT
(Divorced)
State of: __ County of: __
I, __ __ (Full Legal Name), being duly sworn,
do hereby depose and state:
- I am __ __ years of age, born on __ __ (Date) in
(City, Country).
- My current address is:
- My passport number is:
- I declare under oath that:
a) I am currently DIVORCED.
b) I was married to __ __ (Former Spouse's
Full Legal Name) on __ __ (Date) in
__ __ (City, Country).
c) The marriage was legally dissolved by divorce on
__ __ (Date)
in __ __ (City, State/Country).
d) The divorce was finalized in the
__ __ Court
(Name of court), Case Number: __ __.
e) [If applicable] I received a get (Jewish bill of divorce) on
(Date) from the Beth Din of __ __ (City).
f) [If multiple marriages] This was my [first/second/ third] marriage. I was
previously married to:
Name: __ Married: __ __ Divorced: __
[Repeat as needed]
g) I am legally free to remarry according to the laws of
(Country) and [if applicable] according to Jewish law (Halacha).
h) There are no pending legal proceedings related to my divorce.
- Attached to this affidavit are the following documents:
□ Certified copy of final divorce decree/judgment
□ Certified copy of marriage certificate
□ [If applicable] Certificate of get (Jewish divorce)
□ [If applicable] Previous divorce decree(s) from earlier marriage(s)
- I make this affidavit in support of my application for aliyah (immigration)
to the State of Israel.
- I understand that this statement is made under penalty of perjury and that
false statements made herein may result in denial of my application and/or
criminal prosecution.
Signature of Affiant Date
Printed Name
SWORN TO AND SUBSCRIBED before me this __ __ day of
__, 20 __.
[NOTARY SEAL]
Notary Public
My Commission Expires:
SAMPLE 4: WIDOWED
PERSONAL STATUS AFFIDAVIT
(Widowed)
State of: __ County of: __
I, __ __ (Full Legal Name), being duly sworn,
do hereby depose and state:
- I am __ __ years of age, born on __ __ (Date) in
(City, Country).
- My current address is:
- My passport number is:
- I declare under oath that:
a) I am currently WIDOWED.
b) I was married to __ __ (Deceased Spouse's
Full Legal Name) on __ __ (Date) in
__ __ (City, Country).
c) My spouse passed away on __ __ (Date) in
(City, State/Country).
d) The cause of death was:
__ __ [Optional but may be requested]
e) [If applicable] This was my [first/second/third] marriage. I was
previously married to:
Name: __ __ Status: __ __ [divorced/widowed]
Date: __ __ [Repeat as needed]
f) [If applicable - for Jewish law] My deceased spouse and I [had / did not
have] children together.
g) [If applicable - for Jewish law] I [have / have not] received chalitzah
(levirate release) as required under Jewish law.
h) I am legally free to remarry according to the laws of
(Country) and [if applicable] according to Jewish law (Halacha).
- Attached to this affidavit are the following documents:
□ Certified copy of spouse's death certificate
□ Certified copy of marriage certificate
□ [If applicable] Previous divorce decree(s) from earlier marriage(s)
□ [If applicable] Chalitzah certificate from Beth Din
- I make this affidavit in support of my application for aliyah (immigration)
to the State of Israel.
- I understand that this statement is made under penalty of perjury and that
false statements made herein may result in denial of my application and/or
criminal prosecution.
Signature of Affiant Date
Printed Name
SWORN TO AND SUBSCRIBED before me this __ __ day of
__, 20 __.
[NOTARY SEAL]
Notary Public
My Commission Expires:
SAMPLE 5: DIVORCED WITH GET (Detailed Jewish Law Version)
PERSONAL STATUS AFFIDAVIT
(Divorced - With Religious Divorce)
State of: __ County of: __
I, __ __ (Full Legal Name), also known by my
Hebrew name as __ __ (Hebrew Name), being duly
sworn, do hereby depose and state:
- PERSONAL INFORMATION:
a) Date of Birth:
b) Place of Birth:
c) Current Address:
d) Passport Number:
e) Father's Full Name:
f) Mother's Full Name (including maiden name):
- MARRIAGE INFORMATION:
a) I was married to __ __ (Former Spouse's
Full Legal Name), Hebrew name:
__ __.
b) Date of Marriage:
c) Place of Marriage:
d) Type of Ceremony: □ Orthodox Jewish □ Conservative Jewish
□ Reform Jewish □ Civil □ Other:
e) Officiant: __ __ (Name and title)
- CIVIL DIVORCE:
a) Date of Divorce:
b) Court: __ __ (Full court name and location)
c) Case Number:
d) The divorce is final and absolute with no appeals pending.
- RELIGIOUS DIVORCE (GET):
a) I [received / gave] a get (Jewish bill of divorce) on
__ __ (Date).
b) The get was issued by the Beth Din of
(City and rabbinical authority).
c) The presiding dayanim (judges) were:
- Rabbi
- Rabbi
- Rabbi
d) The get was written by:
__ __ (Sofer/Scribe)
e) The get was delivered/received in the presence of proper witnesses.
f) I have in my possession the official certificate of the get.
- CHILDREN FROM MARRIAGE:
□ No children from this marriage
□ Children from this marriage:
Name: __ __ DOB: __ __ Living with:
Name: __ __ DOB: __ __ Living with:
[Add additional as needed]
- PREVIOUS MARRIAGES (if applicable):
□ No previous marriages
□ Previous marriage(s):
Spouse: __ __ Married: __ __ Ended:
__ How: __
[Add documentation for each]
- CURRENT STATUS:
I am legally and religiously free to remarry according to:
a) The civil laws of __ __ (Country)
b) Jewish law (Halacha)
c) There are no impediments to my remarriage
- ATTACHED DOCUMENTS:
□ Certified copy of civil marriage certificate
□ Certified copy of final divorce decree
□ Original or certified copy of get certificate
□ Letter from Beth Din confirming get
□ [If applicable] Divorce documents from previous marriage(s)
- I declare under penalty of perjury that the foregoing is true and correct
to the best of my knowledge and belief.
Signature of Affiant Date
Printed Name / Hebrew Name
SWORN TO AND SUBSCRIBED before me this __ __ day of
__, 20 __.
[NOTARY SEAL]
Notary Public
My Commission Expires:
SUPPORTING LETTER SAMPLE: From Rabbi (for Get)
[RABBI/BETH DIN LETTERHEAD]
Date:
To: Israeli Ministry of Interior / Consulate of Israel RE: Confirmation of Get (Jewish Divorce)
For: __ __ (Full Name)
Hebrew Name:
Dear Sir/Madam,
This is to certify that according to the records of the Beth Din of
__ __ (City), a get (Jewish bill of divorce) was properly executed
between:
HUSBAND: __ (Full Name) Hebrew Name: __ __ Son of: __
AND
WIFE: __(Full Name) Hebrew Name: __ __ Daughter of: __
The get was executed on __ __ (Hebrew Date), corresponding to
__ __ (Civil Date), in accordance with Jewish law (Halacha).
The get was written by: __ __ (Sofer)
The presiding dayanim (judges) were:
- Rabbi
- Rabbi
- Rabbi
Proper witnesses were present, and the get was delivered and accepted according
to all requirements of Jewish law.
Both parties are now free to remarry according to Jewish law.
A certificate of the get bearing the seal of this Beth Din was issued to both
parties.
Sincerely,
Rabbi __ __ [Title and Beth Din]
[OFFICIAL SEAL OF BETH DIN]
CHECKLIST: Before Submitting Your Affidavit
For ALL statuses:
ï [ ] Affidavit completely filled out (no blanks)
ï [ ] Signed in presence of notary
ï [ ] Notary seal is clear and legible
ï [ ] Notary commission hasn't expired
ï [ ] Made copies for your records
ï [ ] Passport-style photo attached (if required)
Additional for MARRIED:
ï [ ] Marriage certificate (certified copy)
ï [ ] Apostille on marriage certificate (if applicable)
ï [ ] Translation of marriage certificate (if needed)
ï [ ] Spouse's ID/passport copy
Additional for DIVORCED:
ï [ ] Final divorce decree (certified copy)
ï [ ] Apostille on divorce decree (if applicable)
ï [ ] Marriage certificate from dissolved marriage
ï [ ] Get certificate (if Jewish marriage)
ï [ ] Rabbi's letter confirming get (if applicable)
ï [ ] All previous divorce documents (if multiple marriages)
Additional for WIDOWED:
ï [ ] Death certificate of spouse (certified copy)
ï [ ] Apostille on death certificate (if applicable)
ï [ ] Marriage certificate
ï [ ] Translation of death certificate (if needed)
ï [ ] Chalitzah certificate (if applicable under Jewish law)
Important Notes About These Samples
**These are templates only **- Always use the official forms provided by:
ï Your local Israeli consulate
ï Jewish Agency office
ï Nefesh B'Nefesh (if applicable)
**Requirements vary **by:
ï Country of origin
ï Israeli consulate jurisdiction
ï Specific circumstances
ï Changes in policy
Before using:
- Verify current requirements with your consulate
- Get the official blank forms
- Have them reviewed by aliyah counselor
- Ensure they meet current Ministry of Interior standards
Common variations:
ï Some consulates have pre-printed forms
ï Some require additional fields
ï Some need witness signatures beyond notary
ï Hebrew translation may be required
Where to Get Official Forms
**1. Israeli Consulate **- Most reliable source for current forms
**2. Jewish Agency **- Provides country-specific packages
**3. Nefesh B'Nefesh **- Has downloadable forms for North Americans
**4. Local aliyah shaliach **- Can provide appropriate forms
Would you like me to create a sample for any specific or unusual situation, or do you need help filling out one of these templates?
Updated on: 01/02/2026
Thank you!