[go: up one dir, main page]
Scribd
Upload
2K views1 page

Self Declaration

This self-declaration form is completed by an individual providing personal details such as name, age, and village, along with a declaration of the truthfulness of the information provided. The individual acknowledges responsibility for the accuracy of the declaration and the consequences of false information under Indian law. Additionally, the form includes a section for stating the family's annual income and caste.

Uploaded by

bharatsiku1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
2K views1 page

Self Declaration

This self-declaration form is completed by an individual providing personal details such as name, age, and village, along with a declaration of the truthfulness of the information provided. The individual acknowledges responsibility for the accuracy of the declaration and the consequences of false information under Indian law. Additionally, the form includes a section for stating the family's annual income and caste.

Uploaded by

bharatsiku1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

SELF DECLARATION

“I Shri / Miss / Mrs. …………………………………………………………………………………………………………

Son of / Daughter of / Wife of …………………………………………………………………………………………………...

Age ……………………………………………………..of Village ……………………………………………………………………..

Po- ………………………………………….. P.S ………………………………………Dist ……………….., Odisha, do

hereby declared that the information given by me in this application form and its self-attested

enclosure is true to the best of my knowledge and that the information furnished is exhaustive

and I have not suppressed any fact. That, I am solely responsible for the accuracy of the

declaration and information furnished and liable for action under section 199, 200 and 420 of

the Indian Penal Code in case of wrong declaration and information. Also, I am well aware of

the fact that the certificate shall be summarily cancelled and all the benefits availed by me shall

be summarily withdrawn in case of wrong declaration and information.”

My family annual income from Salary Rs…………….…….. , Business Rs…………….…Daily Wages

Rs………….……. Agriculture Rs……………….Total annual income of my family near about

Rs……………..And my caste is ………………,

Signature

Date:

You might also like