I ______Son/Daughter/Wife of ______ Resident of _______ District____ do hereby solemnly affirm and declare as follows:
1. That I am citizen of _________.
2. That my permanent residence is House/Flat/Village No.______ Near____ Sector ________District______ State _________.
3. That I am residing in _________ for the at least last _________ years.
4. That I require a _________.
Verified at _________ on this _________ day of _________, _________ that the contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.
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