I _________ son/daughter/wife of _________ resident of _________ do hereby solemnly affirm and declare as under
1. That I have not received any kind of pension from _________ or Non- Govt. Institute and from any other state for the same.
2. That my whole family income is _________ /- per annum.
3. That I am citizen of _________ and residing in _________ for the at least last _________ years.
4. That my correct date of birth /age is _________ years as my date of birth _________.
5. That I am fully entitled to get the old age pension from the _________ Department Govt. or _________.
6. That I am unemployed person.
7. That is my true and correct statement.
I, the above named deponent do hereby verify that the contents of the contents of this affidavit are true and correct to the best of my knowledge.