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l)f~C I ,AIU 'l'IO N

Form - "A"

!Sec rule 5 (1)1

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....~~': '.~.1¢. .. . N() .... .O.':t... .. ~H -~~ A. ........ do hereby declare as fol lows:
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0 F L.E GAL M ET'2 .oU> {J,_ y
I ) That I have filled my appl ication for the post of. Il"sPf; (To f<
. ' -
advertised vide . . . . I~/ 2 oz_ ~
are:
children as today. Their names, sex and dale of birth
2) I have 0 .(~~~V(number) living
011

Sex Da tc of Hirth
Nam e

fied for the appointment

awa re that if! have mor e than two living children, I am liabl e to be disquali
3) I am 11

ro the post.
4) I also declare that: .i::ii-on of legal a-ge-ef
§l~ouse and J have not violated tl,e p10
I am not marr~ ➔ am married and my
marriage. Child Marriage Act, 2006
am awa re that mar ryin g in viol atio n of the provision of the Prohibition of
5) I for.
tion for appointment to the post applied
(Act No. 6 of20 07) shall be disqualifica

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Place: .. ~Y~~.. ,. .4~.4.~ .....

Date: /..

Sign atm e of the applicant