I ______Son/Daughter/Wife of ______ Resident of _______ District____ do hereby solemnly affirm and declare as follows:
1. That my permanent residence is House/Flat/Village No.______ Near____ Sector ________District______ State _________.
2. That I require a residential certificate.
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.