AGE CERTIFICATE

Certified that, I have examined today Sri/ Smt. _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ wife of / Husband of Sri. /Smt. _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ native of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ village _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and his / her age is according
his /her Oral Statement _ _ _ _ _ _ _ _ _ _ _ _ _ years and by appearance is
about _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ years.

MARKS OF IDENTIFICATION

(1)

(2)

Station : Signature :

Date : Designation :