I ________ Son of/ Wife of / Daughter of ________ 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.
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
Attested Signature and official seal of attesting authority