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Self Declaration Form Template

This document is a self-declaration form where the applicant provides personal information including their name, parental details, age, caste, religion, and occupational background. The applicant affirms that the information is true and acknowledges responsibility for its accuracy, with potential legal consequences for false declarations. The form requires the applicant's signature to validate the declaration.

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nirman.pramod
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125 views1 page

Self Declaration Form Template

This document is a self-declaration form where the applicant provides personal information including their name, parental details, age, caste, religion, and occupational background. The applicant affirms that the information is true and acknowledges responsibility for its accuracy, with potential legal consequences for false declarations. The form requires the applicant's signature to validate the declaration.

Uploaded by

nirman.pramod
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 Sri/Miss/Mrs .................................................................................. Son


of / Daughter of / Wife of ................................................................................ ,
Father Name ...................................................................................................... ,
Mother Name..................................................................................................... ,
age …………. , of Village: .............................................................................. ……,
Po: …………………., Ps: ……………………………., Dist: ……………………, Odisha do hereby
declare that the information given by me in this application form & 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.

I belong to Caste / Tribe: ……………………………………….…., Sub-Caste / Sub-


Tribe: ………………………………………..…….., Religion: ………………………………….,

My occupational background is ……………………………………………………. & my


family annual income (from all sources) is ………………………………………………….
(Rupees ………………………………………………………
… ................................................. Only).
I further declare that, I am solely responsible for the accuracy of the
declaration & information furnished & liable for action under section 199 &
200 of the Indian Penal Code in case of wrong declaration & information. Also,
I am well aware of the fact that the certificate shall be summarily withdrawn in
case of wrong declaration & information.

Signature of the applicant

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