ew 2m HQuwmf/ Self Declaration Beene wre, Gduereond arid, grésuniCarcies Agmod / se0b, 2/1B/31 sp0y coir Criisbworer pat OpEd wAsGb De AaphGacd shogiler Aunt De Brgicor Sui wren, coord aptusturG Sp CMM tun Geter gsadscit genersgud gree shlds cismauWled 2 cioronw srosrayid, HS Peudsomid crores wanpssiuioildensd crosayid, pres sofas sacicdacit/ acid eeineowie ypburerona cor Verena AsAuaGs uLvsseo, Dsus gsiemens 1b 177 wHHId 199-cr &H cronbe Flows vif Puen Gages CopGancreiiGid creirieng oyfl@ascin ereirgy wusflmenCain® 2giSuafladlenSneir. 1am Thiru Vetrivel son of Thiru Veeradurai residing at Door No. 2/18/31, street of Rengammal Nagar Village / town of Nachiyarkovil, Taluk of Kumbakonam, Thanjavur District, Tamil Nadu State. The details furnished below by me are true to the best of my knowledge and believe and nothing has been concealed herein. | declare that | am well aware of the fact that if the information and documents given by me are proved to be incorrect / not true in future, | shall be liable for prosecution under section 177 & 199 of the Indian Penal Code. aaa Goad Name aoe] Srisatrapamap /Melatioashipior ‘SL No. 7age ‘deceased T Four 3s Wile of the deceased = Vervel 7 Son of the deceased > ‘Wakieeran 3 Tou of the deceased d - s Signature J w@ipreidr wa Quuriiuis