Government of India
Ministry of External Affairs
CPV Division, Delhi

ANNEXURE A

SPECIMEN AFFIDAVIT TO BE SUBMITTED BY ILLITERATE APPLICANTS AS PROOF OF DATE OF BIRTH IN CASE NO OTHER DOCUMENT MENTIONED AT PARA A (b) OF SECTION IV  IS AVAILABLE

         (To be executed on non-judicial stamp paper)

I S/o W/o D/o .. presently residing at hereby state as follows:

I was born on  . at   situated in the District. .. in the State of ..  I have no documentary proof in support of my place  and date of birth.

I do not possess any educational qualification and I am an illiterate person.

I take oath and solemnly declare/affirm that the particulars furnished by me above are correct and that I have not concealed or misrepresented any facts.

Place

Date ..

Verified on this day of .. of the year ..  that the contents of my above affidavit  are true and correct to the best of my knowledge and belief and nothing in material has been concealed there from.

The contents of the affidavit has been read out to me

Deponent

Attested

Signature and official seal of attesting authority

Note: Affidavit to be attested by the Magistrate/Notary

In case of notary, notarial stamp would be required