GOVERNMENT OF ARUNACHAL PRADESH

VERIFICATION BY HGB/GB

Certified that Shri/Smti/Miss ____________________________________________ S/o W/o D/o

Shri/ Late ______________________________________________________ is a permanent resident of
village ____________________________________________ under _______________________circle
since __________________ years and belongs to ______________________ tribe.

1. *(Name in Block Letters)

Paste recent
passport Size
Photograph for Signature of HGB or GB or Municipal
attestation Councilor with date and seal

RECOMMENDATION BY LOCAL ADMINISTRATIVE OFFICER

Certified that the above information have been verified and recommended for issue of

Permanent Residence Certificate to the applicant.

Paste recent
passport Size (Signature & Office seal)
Photograph for Name: ______________________________
attestation
Designation: _________________________