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Self Declaration

This self-declaration form is completed by an individual affirming their eligibility for a government pension by stating they do not have children in government or private employment, own large businesses or vehicles, or possess significant land. The applicant acknowledges that if any information is found to be false, they accept the cancellation of their pension and will return any funds received. The declaration includes personal details such as name, age, address, and contact information.

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salman.khan8
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3 views1 page

Self Declaration

This self-declaration form is completed by an individual affirming their eligibility for a government pension by stating they do not have children in government or private employment, own large businesses or vehicles, or possess significant land. The applicant acknowledges that if any information is found to be false, they accept the cancellation of their pension and will return any funds received. The declaration includes personal details such as name, age, address, and contact information.

Uploaded by

salman.khan8
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,……………………….……………….…………………., S/O,D/O,W/O………..………….…………………………….,

Age:............, year.................Resident of [Link]............................................... , Urban district,

Madhya Pradesh State, INDIA, (Aadhar Card No...............................................) do hereby solemnly affirm

and state on oath as under:

1. I am not having children who are Govt. Employee / Private sector employment / Private /
Outsourced / Govt. Pensioner / Freedom Fighter pension.

2. I am not having large business Enterprise like oil mills, rice mills, petrol pumps, rig owners,
shop owner etc.

3. I am not Owners of light and/or heavy automobiles (four wheelers and big vehicles.)

4. I am not having land more than 3.0 acres wet/irrigated dry or 7.5 acres dry.

5. I am not any other criterion in which the verification officer may assess by the manner of
lifestyle, occupation and possession of assets rendering the households as ineligible.

That the above facts are true in future if it is proved false I have no objection if my sanctioned

pension is cancelled more over I shall return all the pension amount which I obtained from the

Government by my false representation.

Date:-……………………………

Signature of the applicant / Thumb impression

Mobile No.…………………………………………

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