CERTIFICATE OF RESIDENCE

It is hereby certified that _________________________________

S/o. D/o __________________________________ has residence for a period of more than _____________________ years immediately proceedings the date of issue of this certificate in the following place or place i.e.,

S.No 1 2 3 4 5

Name of the Village

Town / Mandal

District

Period From To

Station: Date: Signature of the Issuing Authority not less than M.R.O