Self-Declaration Form
I ________________________________do hereby declare that the information
given above and in the enclosed documents is true to the best of my knowledge and
belief and nothing has been concealed therein. I am well aware of the fact that if
the information given by me is proved false / not true at any point of time, I will
have to face punishment as per any provision of Law for the time being in force as
well as the benefit availed of by me or the benefit accrued to me shall be
summarily cancelled. I agree with the terms & conditions of Success Roar.
Date: -
Signature of the Applicant