5I furthermore certify that:

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) following a declaration of the testator stating that he was unable to sign his will for the following reason .................................................................................... —I have mentioned this declaration on the will *—the signature has been affixed by ............................................................(name, address) 7(b) the witnesses and I have signed the will; 8*(c) 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) the testator has requested me to include the following statement concerning the safekeeping of his will:................................................................................................