AFFIDAVIT
I, ______________________, resident of __________________________________________, do hereby solemnly affirm and state on oath as under:
- That I was born at _________________ on ________________.
- That I am residing in ________________________ since ____________________
and have the intention of making ____________ my permanent place of residence. - That I own/do not own property (Immovable) in ______________________.
- That I and my parents are Indian Citizens and have not opted for any other nationality.
- That I have hence not applied for or obtained a certificate of domicile from other State.
- That all the statements made by me in any form for the grant of application are correct and true, and I have not concealed any information in the said application.
- I do not claim a Domicile Certificate for any place other than ___________________.
- This affidavit is made by me for producing it to the District Magistrate, __________________________, for the purpose of obtaining a Domicile Certificate.
- That I have renounced my former domicile from the State of my origin, viz. ____________________ State.
Place:
Dated:
Deponent
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