International will; certificate.

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.”