I, , of , resident of , do hereby affirm and declare as follows:
1.That, I am a citizen of India by birth and permanent resident of abovementioned locality.
2.
That my , was born on
at situated at . The name of the father is and the name of the mother is .
3.That my name, recorded in Adhaar Card bearing Adhaar No. , is .
4.That due to ignorance and lack of knowledge regarding the prescribed procedure, I could not apply for registration of the birth and issuance of the Birth Certificate of my , at the time of birth.
5.That the birth of my , has not been registered previously with any Registrar of Births and Deaths, and no Birth Certificate has been issued or obtained in respect thereof.
6.That I am now applying before the competent authority for registration of the birth and issuance of a Birth Certificate in respect of .
7.
That the statement made above are true and correct to the best of my knowledge and belief, and nothing material has been concealed therein.
VERIFICATION
The statements above from para 1 to 7 are true to the best of my knowledge and belief and I have signed this affidavit on
DEPONENT
Solemnly affirm, declare and signed before me by the deponent who is being identified by