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Self Declaration

This self-declaration form is completed by an individual from Rayagada, Odisha, affirming that the information provided is true and complete. The individual acknowledges responsibility for the accuracy of the declaration and understands the legal consequences of providing false information. They also recognize that any benefits obtained through incorrect declarations may be revoked.

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boykhinjilingi
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3 views1 page

Self Declaration

This self-declaration form is completed by an individual from Rayagada, Odisha, affirming that the information provided is true and complete. The individual acknowledges responsibility for the accuracy of the declaration and understands the legal consequences of providing false information. They also recognize that any benefits obtained through incorrect declarations may be revoked.

Uploaded by

boykhinjilingi
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

SELF DECLARATION

I Shri/Miss/ Mrs._______________________________________________________________Son Of / daughter of /


Wife of____________________________________________age___________Year’s of Village___________________
Tehsil* / Block*__________________________ Police Station_________________________ post_________________
District/sub - district-Rayagada in the state of Odisha, do hereby declare that information given by me this application
form and its self -attested enclosures 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 an information
furnished and liable for action under section 199 and 200 of the Indian Penal code in caser of wrong declaration and
information. Also I am well aware of the fact that the certificate shall be summarily cancelled and all the benefit availed
by me shall be summarily withdrawn in care of wrong declaration and information.

DECLARTION SIG.

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