शपथ पत्र
मैं पुत्र निवासी गांव डाकखाना तहसील ढटवाल जिला
हमीरपुर हि0 प्र 0
आयु साल की निम्नलिखित सत्यापन करता हूं -----
1 यह कि
मैं हिमाचल प्रदेश का स्थायी निवासी हूं ।
2 यह मेरे परिवार में कोई भी सदस्य सरकारी / गैर-सरकारी नौकरी पर नहीं है ।
कि
3 यह कि
हमारी कोई दुकान नहीं है ।
4 यह मुझे घर / दुकान से कोई भी किराया नहीं आता है ।
कि
5 यह कि
मैं मजदूरी करता हूं ।
6 यह कि
मेरे नाम कोई भी कामर्शिअल गाडी नहीं है ।
7 यह कि
हमारे परिवार का भुमि से संबंधी आय तथा परिवार की कुल आय मु0
रुपये बनती है ।
8 यह कि मेरा घर 2500 स्केयर फुट से कम है ।
9 यह कि हमारे परिवार की भूमि रुरल एरिया में एक हैक्टेयर से कम है ।
10 यह कि अरवन एरिया में मेरे परिवार के नाम कोई जमीन नहीं है ।
11 यह कि मेरे और मेरे परिवार के नाम पटवारी रिपोर्ट में वर्णित भूमि के अलावा
और कोई भूमि नहीं है ।
12 यह कि हमारे परिवार का Residential Plot, Notified Municipalities में 100 Sq. Yard नहीं
है ।
13 यह कि हमारे परिवार से कोई भी Central Govt. , State Govt. Board, Corporations and
autonomous bodies and Public Sector Undertaking etc. में Regular / Contract Employees
नहीं है ।
शपथकार
उक्त व्यान हल्फी में दिए गए तथ्य मेरी जानकारी के अनुसार सही है । इसमें कोई भी तथ्य
छुपाया नहीं गया है ।
शपथकार
दिनांक
स्थान
Self Affidavit
I, age………..years S/o …………………………………… R/o Vill. ………………… P.O………………..
Tehsil …………….. Distt. Hamirpur H.P. do hereby solemnly affirm on oath as under.
1 That there is no member of my family in Govt./ semi Govt. / autonomous body / board/
corporation etc.
2 That I am unemployed at present.
3 That the contents of this affidavit are true and correct.
Date : Deponent
Place:
Verification :- I, the above named deponent verified that the above written contents are true and
correct nothing has been concealed therein.
Date :- Deponent
Place :-
Self attested
Self Affidavit
I, age………..years S/o …………………………………… R/o Vill. ………………… P.O………………..
Tehsil …………….. Distt. Hamirpur H.P. do hereby solemnly affirm on oath as under.
1 That nor I and no other member of my family in Govt./ semi Govt. / autonomous body / board/
corporation etc.
2 That the total income of my family do not exceed Rs. 6,50,000/-.
3 That total income of my family from all sources is Rs.
4 That I belong to Cast which belong to OBC community as per Govt. notification.
5 That I do, not belong to the creamy Layer criteria applicable for OBC Cast as per Govt.
notification.
6 That I fulfill all the conditions applicable for the not creamy layer criteria of OBC Caste as
mentioned in Govt. Notification.
7 That the above statement is true and correct.
Date : Deponent
Place:
Verification :- I, the above named deponent verified that the above written contents are true and
correct nothing has been concealed therein.
Date :- Deponent
Place :-
Self attested
Self Affidavit
I, age………..years S/o …………………………………… R/o Vill. ………………… P.O………………..
Tehsil …………….. Distt. Hamirpur H.P. do hereby solemnly affirm on oath as under.
1 That my ___________________ is owner of possession of land _______________ hect. In tikka
_______________ P.O. _______________ Tehsil _____________ Distt. Hamirpur H.P. which is less then
one hect.
2 That the above statement is true and correct.
3 That except above noted land I have no land in my / family name in HP or elsewhere in India.
Date : Deponent
Place:
Verification :- I, the above named deponent verified that the above written contents are true and
correct nothing has been concealed therein.
Date :- Deponent
Place :-
Self attested
