This is certify that the under mentioned particulars are correct and true solemnly declare that the documents submitted by me are true and details is given as under: –
NAME : _________
FATHER’S NAME : _________
RESIDENTIAL ADDRESS : _________
CATEGORY : OLD AGE
ELIGIBILITY : MY AGE IS _________
This is also certify that I have no source of incomes and direly need of pension recommended by the _________ and I have not applied/not taking any pension from any Organization i.e. _________ Government/Central Government /any _________ except this pension I am also residing _________ for more than _________ years.
All the above details are true and correct and nothing has been concealed if any instant is noticed in this regards i will be fully responsible for the same.