(FOR HIGHER STUDY)
SELF-DECLARATION
I HIMANSU BHUYAN, S/O- GANESH CHANDRA BHUYAN presently residing at Plot No-8/820,
Lane-13, Jagannath Vihar, Baramunda, Bhubaneswar do hereby declare that I require this certificate for
higher study purpose.
In the event of any change in the particulars given above which affect my eligibility for Children
Education Allowance, I undertake to intimate the same promptly and refund excess payment, if any
made to me.
Place:- KOLKATA
Date:- 03.04.2025
Signature:
Name: NITYANAND PANDEY
Emp. ID: 119397
Designation: Director (Chemistry)
Unit: GEOLOGICAL SURVEY OF INDIA,
CCL, CHQ, KOLKATA-16