Affidavit for PMGDISHA Scheme to be furnished by CSCs

Yogendra prasad Shukla S/O Heera lal Shukla Aged 41 Years,

Representing Digital seva Common service center & 672763560019
(Name & CSC ID of CSC center ) in the official capacity of owner or the above
center and Having its address at Vill - Mamdar Post - mamdar Distt- Sidhi
(complete address) do here by state on solemn affirmation as under:

1. I am owner of the CSC bearing Registration No. 672763560019 (CSC ID),In the
State Madhya Pradesh registered under CSC e-Governences Private limited
(Mention Whichever is applicable to Your organization – Companies
Act/Registered Society/ Private Limited Public Limited/ Public Sector
Undertaking/Trust,Proprietorship Firm,Partnership firm/other etc. ) in India,
Having Permanent Income Tax Account Number(PAN) BTSPS9512H Aadhaar
No. 212745403425
2. My CSC Center Digital Seva Common Service center Mamdar Distt- Sidhi is
empanelled as a Training Center under the Pradhan Mantri Digital Saksharta
Abhiyan (PMGDISHA) Scheme of Ministry of Electronics and Information
Technology (MeitY), Government of india being implemented through CSC e-
Governance Service India Limited (in the capacity of PMGDISHA PMU
),hereinafter referred as CSC-SPV.The Scheme is hearinafter referred as
PMGDISHA Scheme. The brief details of the scheme are given Annerure-I.