ANNEXURE “E”

AFFIDAVIT

I, Shri/Smt.__________________________________ son/daughter of _______

____________________________________________ age _____________ resident of
__________________; Indian National do hereby on solemn affirmation state on oath as
under:-

1. I say that I am residing at the above mentioned address alongwith my parents

since birth.

2. I say that I belong to_______________ Community as my parents also belong to

the same ___________ Community.

3. I say that I am swearing this affidavit in order to get O.B.C. Certificate from the
Mamlatdar of ______________ in order to produce the same to _____________
for the purpose of ___________________________________.

4. I say that I am not belonging to the section (Creamylayer) mentioned in column 3

of the schedule of the Government of India Department of Personnel and
Training O.M. No. 36012/22/95 ESTT (SCT) dated 08.09.1993 and that the
annual income from all sources of my family is Rs.____________________.

5. I say that the contents of above paras of my affidavit are true to the best of my
knowledge and belief and that I have not mispresented any facts.

Place :-

Date :-

Deponent

Identified by:-

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