Government
of India
Ministry of External Affairs
CPV Division, Delhi
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Government
of India |
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