izi= vtZnkjkpk QksVks

Lo;a & lk{kkaduklkBh Lo;a?kks’k.kki=

eh -----------------------------------------------------------------Jh---------------------------------------------------------------;kapk eqyxk
@eqyxh o;--------- o’kZ]vk/kkj dzekad ¼vlY;kl½ ------------------------------------------O;olk; ------------------
----------- jkg.kkj---------------------------------------;kn`kjs ?kksf’kr djrks@djrs dh] ojhy loZ ekfgrh
ekÖ;k O;Drhxr ekfgrh o letwrhuqlkj [kjh vkgs- lnj ekfgrh [kksVh vk<Gwu
vkY;kl] Hkkjrh; naM lafgrk vUo;s vkf.k @ fdaok lacfa /kr dk;n;kuqlkj ekÖ;koj
[kVyk Hkjyk tkbZy o R;kuqlkj eh f”k{ksl ik= jkghu ;kph iw.kZ tk.kho vkgs-

fBdk.k %& vtZnkjkph lgh %&

fnukad %& vtZnkjkps uko %&

&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
Annexure
Self-Declaration for self-Attestation
Applicant’s Photo

I ………………………………………………………………..Son/Daughter of………………………………………………………..

Aged………..,occupation………………………………...resident of…………………………………………………………

With UID No…………………………………………………………………………………………..hereby declare that the

Copies attested by me are true copies of original documents. I am well aware of the fact that if

The copies are found to be false, I shall be liable for prosecution and punishment Under Indian

Penal Code and / or any other law applicable thereto.

Place:- Applicant’s Signature :-

Date:- Applicant’s Name :-