The authorized person shall attach to the will a certificate to be signed by him establishing that the requirements of this article 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)
I,................... (name, address and capacity), a person authorized to act in connection with international wills Certify that on.................(date)............... (place) (testator)........................... (name, address, date and place of birth)in my presence and that of the witnesses (a)............................. (name, address, date and place of birth) (b)............................. (name, address, date and place of birth) has declared that the attached document is his will and that he knows the contents thereof.
I furthermore certify that:
PLACE OF EXECUTION
DATE
SIGNATURE and, if necessary, SEAL.
* to be completed if appropriate
Va. Code § 64.2-437