I _________ son/daughter/wife of _________ resident of _________ do hereby Solemnly affirm and declare as under:
1. That I am citizen of _________.
2. That I have not taken loan from _________.
3. That I have no loan in any _________.
4. That I have been residing at _________ since _________ years and doing business/working _________.
5. That I am will deposit installment time to time, that I shall declare indemnity that I shall deposit my loan in time.
6. That it is my true and correct statement.
Verified at _________ on this _________ Day of _________ that the contents of the above affidavit are true to the best of my knowledge and belief.