AFFIDAVIT

I ______Son/Daughter/Wife of ______ Resident of _______ District____ do hereby solemnly affirm and declare as follows:

1.    That I am citizen of _________.
2.    That my permanent residence is ________District______ State _________.
3.    That I am Continuous residing in _________ state for the at least last _________ years.
4.    That my Place & Date of Birth is _________ & _________.
5.    That I have never obtained a domicile certificate from any other place.
6.    That I am giving _________ documents as proof for applying Domicile in _________.
7.    That I am obtaining Domicile Certificate for _________.

Deponent

VERIFICATION:

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.

Deponent

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