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 wills2." 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:14." SIGNATURE and, if necessary, SEAL."Apr. 27, 2001, D.C. Law 13-292, § 102(b), 48 DCR 2087.